Provider Demographics
NPI:1578973509
Name:EDELSTEIN FAMILY AND SPORTS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:EDELSTEIN FAMILY AND SPORTS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:EDELSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:603-382-8834
Mailing Address - Street 1:PO BOX 1195
Mailing Address - Street 2:
Mailing Address - City:PLAISTOW
Mailing Address - State:NH
Mailing Address - Zip Code:03865-1195
Mailing Address - Country:US
Mailing Address - Phone:603-382-8834
Mailing Address - Fax:603-382-1536
Practice Address - Street 1:28 OLD RD
Practice Address - Street 2:
Practice Address - City:PLAISTOW
Practice Address - State:NH
Practice Address - Zip Code:03865-2928
Practice Address - Country:US
Practice Address - Phone:603-382-8834
Practice Address - Fax:603-382-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH567-0899111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHU88658Medicare UPIN