Provider Demographics
NPI:1821044710
Name:COLARUSSO, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:COLARUSSO
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 1:49 S ROUTE 9W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVERSTRAW
Mailing Address - State:NY
Mailing Address - Zip Code:10993-1021
Mailing Address - Country:US
Mailing Address - Phone:845-429-5200
Mailing Address - Fax:845-429-5638
Practice Address - Street 1:49 S ROUTE 9W
Practice Address - Street 2:
Practice Address - City:WEST HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10993-1021
Practice Address - Country:US
Practice Address - Phone:845-429-5200
Practice Address - Fax:845-429-5638
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8464111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7G631Medicare UPIN
NYX7G631Medicare ID - Type Unspecified