Provider Demographics
NPI:1659634095
Name:DIAGNOSTIC CHIROPRACTIC PC
Entity Type:Organization
Organization Name:DIAGNOSTIC CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-307-1345
Mailing Address - Street 1:595 STEWART AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4787
Mailing Address - Country:US
Mailing Address - Phone:516-307-1345
Mailing Address - Fax:516-307-1351
Practice Address - Street 1:595 STEWART AVE
Practice Address - Street 2:SUITE 750
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-4787
Practice Address - Country:US
Practice Address - Phone:516-307-1345
Practice Address - Fax:516-307-1351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005822111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty