Provider Demographics
NPI:1669838447
Name:NEW YORK SPORTS & SPINE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NEW YORK SPORTS & SPINE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-381-7575
Mailing Address - Street 1:875 MAMARONECK AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:914-381-7575
Mailing Address - Fax:914-381-7578
Practice Address - Street 1:875 MAMARONECK AVENUE
Practice Address - Street 2:STE 102
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-381-7575
Practice Address - Fax:914-381-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011532111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty