Provider Demographics
NPI:1508121377
Name:RYE ACTIVE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:RYE ACTIVE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-409-8385
Mailing Address - Street 1:31 PURCHASE ST
Mailing Address - Street 2:SUITE 2-3
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3013
Mailing Address - Country:US
Mailing Address - Phone:914-409-8385
Mailing Address - Fax:
Practice Address - Street 1:31 PURCHASE ST
Practice Address - Street 2:SUITE 2-3
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-3013
Practice Address - Country:US
Practice Address - Phone:914-409-8385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012102111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty