Provider Demographics
NPI:1285035543
Name:PHELTS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PHELTS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WESLY
Authorized Official - Last Name:PHELTS
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:646-490-9600
Mailing Address - Street 1:124 E 40TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1723
Mailing Address - Country:US
Mailing Address - Phone:212-286-2012
Mailing Address - Fax:866-526-3554
Practice Address - Street 1:124 E 40TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1723
Practice Address - Country:US
Practice Address - Phone:212-286-2012
Practice Address - Fax:866-526-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010658111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7Q831Medicare PIN