Provider Demographics
NPI:1467644989
Name:BALTSAS CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BALTSAS CHIROPRACTIC, PC
Other - Org Name:BALTSAS CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BALTSAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-565-6290
Mailing Address - Street 1:299 FULLERTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3723
Mailing Address - Country:US
Mailing Address - Phone:845-565-6290
Mailing Address - Fax:845-565-6290
Practice Address - Street 1:299 FULLERTON AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3723
Practice Address - Country:US
Practice Address - Phone:845-565-6290
Practice Address - Fax:845-565-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7W251Medicare PIN