Provider Demographics
NPI:1720391691
Name:MILLBROOK CHIROPRACTIC OFFICE LLC
Entity Type:Organization
Organization Name:MILLBROOK CHIROPRACTIC OFFICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:845-677-6381
Mailing Address - Street 1:PO BOX 1382
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:12545-1382
Mailing Address - Country:US
Mailing Address - Phone:845-677-6381
Mailing Address - Fax:
Practice Address - Street 1:3208 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5918
Practice Address - Country:US
Practice Address - Phone:845-677-6381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009112-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty