Provider Demographics
NPI:1760727564
Name:SIGNATURE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SIGNATURE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMCHARAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-626-9037
Mailing Address - Street 1:536 WADLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-3713
Mailing Address - Country:US
Mailing Address - Phone:347-626-9037
Mailing Address - Fax:
Practice Address - Street 1:155 POWERS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-4973
Practice Address - Country:US
Practice Address - Phone:347-626-9037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012162111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty