Provider Demographics
NPI:1184955247
Name:LEXINGTON AVENUE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:LEXINGTON AVENUE CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:646-530-4806
Mailing Address - Street 1:192 LEXINGTON AVE
Mailing Address - Street 2:SUITE 233
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6823
Mailing Address - Country:US
Mailing Address - Phone:212-802-1433
Mailing Address - Fax:
Practice Address - Street 1:192 LEXINGTON AVE
Practice Address - Street 2:SUITE 233
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6823
Practice Address - Country:US
Practice Address - Phone:212-802-1433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011717111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty