Provider Demographics
NPI:1801035688
Name:WEST 16TH SPORTS CHIROPRACTIC PC
Entity Type:Organization
Organization Name:WEST 16TH SPORTS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CONIGLIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-633-6123
Mailing Address - Street 1:246 W 16TH ST
Mailing Address - Street 2:STE. 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6101
Mailing Address - Country:US
Mailing Address - Phone:212-633-6123
Mailing Address - Fax:
Practice Address - Street 1:246 W 16TH ST
Practice Address - Street 2:STE. 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6101
Practice Address - Country:US
Practice Address - Phone:212-633-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY13853OtherATLANTIS
NYX005592OtherSTATE LICENSE
NYP643889OtherOXFORD
NY13853OtherATLANTIS