Provider Demographics
NPI:1437228640
Name:OLYMPUS CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:OLYMPUS CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KESSELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-374-2222
Mailing Address - Street 1:7050 AUSTIN ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4737
Mailing Address - Country:US
Mailing Address - Phone:718-374-2222
Mailing Address - Fax:718-374-1113
Practice Address - Street 1:7050 AUSTIN ST
Practice Address - Street 2:SUITE 108
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4737
Practice Address - Country:US
Practice Address - Phone:718-374-2222
Practice Address - Fax:718-374-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008765111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU68130Medicare UPIN
NY02623Medicare ID - Type Unspecified