Provider Demographics
NPI:1992835169
Name:BOSTROEM CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:BOSTROEM CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BOSTROEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC,MPH
Authorized Official - Phone:718-624-4848
Mailing Address - Street 1:85 LIVINGSTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5031
Mailing Address - Country:US
Mailing Address - Phone:718-624-4848
Mailing Address - Fax:718-624-4460
Practice Address - Street 1:85 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5031
Practice Address - Country:US
Practice Address - Phone:718-624-4848
Practice Address - Fax:718-624-4460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004403-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
XCWLS1Medicare PIN
NYT53039Medicare UPIN