Provider Demographics
NPI:1770666166
Name:CO-OP CITY CHIROPRACTIC P C
Entity Type:Organization
Organization Name:CO-OP CITY CHIROPRACTIC P C
Other - Org Name:DR HENRY HALL
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:DR OF CHIROPRACTIC
Authorized Official - Phone:718-379-1000
Mailing Address - Street 1:2100 BARTOW AVE
Mailing Address - Street 2:SUITE 227
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4614
Mailing Address - Country:US
Mailing Address - Phone:718-320-9000
Mailing Address - Fax:718-320-9380
Practice Address - Street 1:2100 BARTOW AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-4614
Practice Address - Country:US
Practice Address - Phone:718-320-9000
Practice Address - Fax:718-320-9380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0043541111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY043349OtherWEB
1094808000OtherUS DEPT OF LABOR
T52756Medicare UPIN
X23661Medicare ID - Type Unspecified