Provider Demographics
NPI:1275817181
Name:LORRAINE DEL ROSSO CHIROPRACTIC,DIETETICS,AND NUTRITION,PLLC
Entity Type:Organization
Organization Name:LORRAINE DEL ROSSO CHIROPRACTIC,DIETETICS,AND NUTRITION,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL ROSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:518-496-2142
Mailing Address - Street 1:P O BOX 1153
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-0153
Mailing Address - Country:US
Mailing Address - Phone:518-899-9199
Mailing Address - Fax:518-899-9199
Practice Address - Street 1:19 KENDALL WAY
Practice Address - Street 2:SHOPS OF MALTA
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020
Practice Address - Country:US
Practice Address - Phone:518-899-9199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004015-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5676OtherMEDICARE PTAN
NYT26668Medicare UPIN