Provider Demographics
NPI:1851521686
Name:CHIROPRACTIC REHABILITATION SOURCE P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC REHABILITATION SOURCE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:HILARIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:715-597-9287
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:SLOATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10974-0172
Mailing Address - Country:US
Mailing Address - Phone:845-517-0222
Mailing Address - Fax:
Practice Address - Street 1:9 INGALLS ST
Practice Address - Street 2:STE 41
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2318
Practice Address - Country:US
Practice Address - Phone:845-517-0222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010986-1261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX07N51OtherMEDICARE
NYV07012Medicare UPIN