Provider Demographics
NPI:1922248665
Name:DASHA WELLNESS CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:DASHA WELLNESS CHIROPRACTIC, PC
Other - Org Name:DASHA WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:POLLACK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-301-3488
Mailing Address - Street 1:440 E 62ND ST
Mailing Address - Street 2:SUITE 14D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-8340
Mailing Address - Country:US
Mailing Address - Phone:212-755-5051
Mailing Address - Fax:
Practice Address - Street 1:440 E 62ND ST
Practice Address - Street 2:SUITE 14D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-8340
Practice Address - Country:US
Practice Address - Phone:212-755-5051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008979111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6A421OtherMEDICARE