Provider Demographics
NPI:1467901280
Name:INTEGRATED CHIROPRACTIC
Entity Type:Organization
Organization Name:INTEGRATED CHIROPRACTIC
Other - Org Name:DR. S MATRANGOLO DC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:MATRANGOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-980-6903
Mailing Address - Street 1:2052 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2583
Mailing Address - Country:US
Mailing Address - Phone:718-980-6903
Mailing Address - Fax:718-980-6905
Practice Address - Street 1:2052 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2583
Practice Address - Country:US
Practice Address - Phone:718-980-6903
Practice Address - Fax:718-980-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty