Provider Demographics
NPI:1811202922
Name:BRONX CHIROPRACTIC SERVICES PC
Entity Type:Organization
Organization Name:BRONX CHIROPRACTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SUPER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-307-1345
Mailing Address - Street 1:595 STEWART AVE
Mailing Address - Street 2:SUITE 750
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-4787
Mailing Address - Country:US
Mailing Address - Phone:516-307-1345
Mailing Address - Fax:
Practice Address - Street 1:1957 SOUTHERN BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-1419
Practice Address - Country:US
Practice Address - Phone:347-590-7094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty