Provider Demographics
NPI:1548415482
Name:WESTSIDE CHIROPRACTIC WELLNESS AND REHABILITATION PLLC
Entity Type:Organization
Organization Name:WESTSIDE CHIROPRACTIC WELLNESS AND REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:YAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-315-1412
Mailing Address - Street 1:311 W 43RD ST # T
Mailing Address - Street 2:#1101
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:311 W 43RD ST # T
Practice Address - Street 2:#1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6413
Practice Address - Country:US
Practice Address - Phone:212-315-1412
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010026-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty