Provider Demographics
NPI:1447556824
Name:PICO FAMILY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:PICO FAMILY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:PICO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-765-1333
Mailing Address - Street 1:162 W 56TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3831
Mailing Address - Country:US
Mailing Address - Phone:212-765-1333
Mailing Address - Fax:212-765-1199
Practice Address - Street 1:162 W 56TH ST
Practice Address - Street 2:STE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3831
Practice Address - Country:US
Practice Address - Phone:212-765-1333
Practice Address - Fax:212-765-1199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007730111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX007730OtherLICENSE