Provider Demographics
NPI:1952509564
Name:BLUE MOUNTAIN CHIROPRACTIC FAMILY WELLNESS CENTER P.C.
Entity Type:Organization
Organization Name:BLUE MOUNTAIN CHIROPRACTIC FAMILY WELLNESS CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:REUBEN
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-737-7333
Mailing Address - Street 1:3901 CROMPOND RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7232
Mailing Address - Country:US
Mailing Address - Phone:914-737-7333
Mailing Address - Fax:914-736-2183
Practice Address - Street 1:3901 CROMPOND RD
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-7216
Practice Address - Country:US
Practice Address - Phone:914-737-7333
Practice Address - Fax:914-736-2183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty