Provider Demographics
NPI:1467785741
Name:BROADWAY CHIROPRACTIC AND WELLNESS
Entity Type:Organization
Organization Name:BROADWAY CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-354-2225
Mailing Address - Street 1:1410 BROADWAY
Mailing Address - Street 2:CONCOURSE LEVEL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-5007
Mailing Address - Country:US
Mailing Address - Phone:212-354-2225
Mailing Address - Fax:212-354-1954
Practice Address - Street 1:1410 BROADWAY
Practice Address - Street 2:CONCOURSE LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-5007
Practice Address - Country:US
Practice Address - Phone:212-354-2225
Practice Address - Fax:212-354-1954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX8414111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty