Provider Demographics
NPI:1851675268
Name:CONCOURSE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CONCOURSE CHIROPRACTIC PLLC
Other - Org Name:PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEDASIE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-733-1000
Mailing Address - Street 1:2676 GRAND CONCOURSE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-4914
Mailing Address - Country:US
Mailing Address - Phone:718-733-1000
Mailing Address - Fax:718-733-0351
Practice Address - Street 1:2676 GRAND CONCOURSE
Practice Address - Street 2:SUITE A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4914
Practice Address - Country:US
Practice Address - Phone:718-733-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0046381302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11OtherTAXONOMY CODE
NY111N00000XOtherTAXONOMY CODE