Provider Demographics
NPI:1912559105
Name:R.L CHIROPRACTIC DIAGNOSTIC PC
Entity Type:Organization
Organization Name:R.L CHIROPRACTIC DIAGNOSTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:LUCA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-502-5271
Mailing Address - Street 1:1835 RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-2560
Mailing Address - Country:US
Mailing Address - Phone:718-502-5271
Mailing Address - Fax:718-701-1188
Practice Address - Street 1:1835 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2560
Practice Address - Country:US
Practice Address - Phone:718-502-5271
Practice Address - Fax:718-701-1188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty