Provider Demographics
NPI:1275937039
Name:NOVA CHIROPRACTIC SERVICES PC
Entity Type:Organization
Organization Name:NOVA CHIROPRACTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-419-3190
Mailing Address - Street 1:3009 45TH ST
Mailing Address - Street 2:STE 2FT
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-1848
Mailing Address - Country:US
Mailing Address - Phone:914-419-3190
Mailing Address - Fax:800-520-5573
Practice Address - Street 1:6860 AUSTIN ST
Practice Address - Street 2:SUITE 404
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4245
Practice Address - Country:US
Practice Address - Phone:914-419-3190
Practice Address - Fax:800-520-5573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty