Provider Demographics
NPI:1689883357
Name:NORTHERN BROOKLYN CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:NORTHERN BROOKLYN CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:D'AVANZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-403-9000
Mailing Address - Street 1:189 MONTAGUE ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3610
Mailing Address - Country:US
Mailing Address - Phone:718-403-9000
Mailing Address - Fax:718-403-0166
Practice Address - Street 1:189 MONTAGUE ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3610
Practice Address - Country:US
Practice Address - Phone:718-403-9000
Practice Address - Fax:718-403-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty