Provider Demographics
NPI:1467739763
Name:CHIROPRACTIC SPORTS REHABILITATION PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC SPORTS REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FERDINAND
Authorized Official - Middle Name:ANDREAS
Authorized Official - Last Name:ESSER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-310-1516
Mailing Address - Street 1:172 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-1810
Mailing Address - Country:US
Mailing Address - Phone:914-310-1516
Mailing Address - Fax:
Practice Address - Street 1:2127 CROMPOND RD STE 104B
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4328
Practice Address - Country:US
Practice Address - Phone:914-930-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
NYX004874-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52979Medicare UPIN