Provider Demographics
NPI:1982185856
Name:STATEN ISLAND SPORTS CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:STATEN ISLAND SPORTS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-667-2190
Mailing Address - Street 1:PO BOX 60710
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-0710
Mailing Address - Country:US
Mailing Address - Phone:718-667-2190
Mailing Address - Fax:718-667-7279
Practice Address - Street 1:2052 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-2583
Practice Address - Country:US
Practice Address - Phone:718-667-2190
Practice Address - Fax:718-667-7279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty