Provider Demographics
NPI:1376078584
Name:45TH STREET CHIROPRACTIC
Entity Type:Organization
Organization Name:45TH STREET CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CAROLLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:646-582-6955
Mailing Address - Street 1:PO BOX 630447
Mailing Address - Street 2:
Mailing Address - City:LITTLE NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11363-0447
Mailing Address - Country:US
Mailing Address - Phone:646-582-6955
Mailing Address - Fax:646-582-6955
Practice Address - Street 1:6 E 45TH ST
Practice Address - Street 2:18 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-2401
Practice Address - Country:US
Practice Address - Phone:718-744-4137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-25
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty