Provider Demographics
NPI:1881824308
Name:NYC CHIROPRACTIC, PHYSICAL THERAPY & ACUPUNCTURE, PLLC
Entity Type:Organization
Organization Name:NYC CHIROPRACTIC, PHYSICAL THERAPY & ACUPUNCTURE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:R
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-962-2262
Mailing Address - Street 1:291 BROADWAY
Mailing Address - Street 2:SUITE 1105
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1814
Mailing Address - Country:US
Mailing Address - Phone:212-962-2262
Mailing Address - Fax:212-962-7472
Practice Address - Street 1:291 BROADWAY
Practice Address - Street 2:SUITE 1105
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1814
Practice Address - Country:US
Practice Address - Phone:212-962-2262
Practice Address - Fax:212-962-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008751111N00000X
NY032554208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty