Provider Demographics
NPI:1326219296
Name:CHIROSPA CHIROPRACTIC PC
Entity Type:Organization
Organization Name:CHIROSPA CHIROPRACTIC PC
Other - Org Name:NATURAL CARE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-425-2600
Mailing Address - Street 1:46 GERARD ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-6944
Mailing Address - Country:US
Mailing Address - Phone:631-425-2600
Mailing Address - Fax:631-425-3098
Practice Address - Street 1:46 GERARD ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-6944
Practice Address - Country:US
Practice Address - Phone:631-425-2600
Practice Address - Fax:631-425-3098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008607-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100001731OtherMEDICARE PTAN
NYA100001731Medicare PIN