Provider Demographics
NPI:1407951957
Name:MND CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:MND CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:COLARUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-358-7828
Mailing Address - Street 1:2244 PALISADES CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-6402
Mailing Address - Country:US
Mailing Address - Phone:845-358-7828
Mailing Address - Fax:845-358-4484
Practice Address - Street 1:2244 PALISADES CENTER DR
Practice Address - Street 2:
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-6402
Practice Address - Country:US
Practice Address - Phone:845-358-7828
Practice Address - Fax:845-358-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty