Provider Demographics
NPI:1548800550
Name:5TH AVE CHIROPRACTIC NYC PC
Entity Type:Organization
Organization Name:5TH AVE CHIROPRACTIC NYC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAUB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-624-0886
Mailing Address - Street 1:35 W 45TH ST FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-4903
Mailing Address - Country:US
Mailing Address - Phone:917-624-0886
Mailing Address - Fax:
Practice Address - Street 1:35 W 45TH ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-4903
Practice Address - Country:US
Practice Address - Phone:917-624-0886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty