Provider Demographics
NPI:1649208588
Name:CASTRO, NELSON (DC)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:
Last Name:CASTRO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3244 31ST ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-2630
Mailing Address - Country:US
Mailing Address - Phone:718-956-6565
Mailing Address - Fax:718-956-7463
Practice Address - Street 1:3244 31ST ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-2630
Practice Address - Country:US
Practice Address - Phone:718-956-6565
Practice Address - Fax:718-956-7463
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007629111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU89035Medicare UPIN
NY07913HMedicare PIN
NY07747JMedicare PIN