Provider Demographics
NPI:1790141026
Name:CASTRO, MICHAEL RALPH (DC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RALPH
Last Name:CASTRO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N MIDDLETOWN RD
Mailing Address - Street 2:STE 2
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-1262
Mailing Address - Country:US
Mailing Address - Phone:845-620-0939
Mailing Address - Fax:845-620-0940
Practice Address - Street 1:300 N MIDDLETOWN RD
Practice Address - Street 2:STE 2
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-1262
Practice Address - Country:US
Practice Address - Phone:845-620-0939
Practice Address - Fax:845-620-0940
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012777-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor