Provider Demographics
NPI:1457492126
Name:AXELROD, BRETT (DC)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:AXELROD
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 S CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-3505
Mailing Address - Country:US
Mailing Address - Phone:914-345-6700
Mailing Address - Fax:914-345-6025
Practice Address - Street 1:64 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ELMSFORD
Practice Address - State:NY
Practice Address - Zip Code:10523-3505
Practice Address - Country:US
Practice Address - Phone:914-345-6700
Practice Address - Fax:914-345-6025
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006838-1111N00000X, 111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4R99OtherBCBS PIN
NYX4R99OtherBCBS PIN