Provider Demographics
NPI:1629564950
Name:BROWNSVILLE CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:BROWNSVILLE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-676-5775
Mailing Address - Street 1:409 ROCKAWAY AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11212-5635
Mailing Address - Country:US
Mailing Address - Phone:914-648-8865
Mailing Address - Fax:718-676-5774
Practice Address - Street 1:409 ROCKAWAY AVE FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-5635
Practice Address - Country:US
Practice Address - Phone:914-648-8865
Practice Address - Fax:718-676-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008968261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3776776Medicaid