Provider Demographics
NPI:1518996727
Name:SPINAL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SPINAL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:BUBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-812-0569
Mailing Address - Street 1:2775 E 12TH ST
Mailing Address - Street 2:528
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-4655
Mailing Address - Country:US
Mailing Address - Phone:718-812-0569
Mailing Address - Fax:718-648-9307
Practice Address - Street 1:265 AVENUE X
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-5939
Practice Address - Country:US
Practice Address - Phone:718-812-0569
Practice Address - Fax:718-648-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010911111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXDWHV1Medicare PIN