Provider Demographics
NPI:1275835365
Name:CHIROPRACTIC AT WALL STREET PC
Entity Type:Organization
Organization Name:CHIROPRACTIC AT WALL STREET PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-792-9292
Mailing Address - Street 1:30 BROAD ST
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-2304
Mailing Address - Country:US
Mailing Address - Phone:212-792-9292
Mailing Address - Fax:212-792-9496
Practice Address - Street 1:30 BROAD ST
Practice Address - Street 2:SUITE 2005
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-2304
Practice Address - Country:US
Practice Address - Phone:212-792-9292
Practice Address - Fax:212-792-9496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011568-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty