Provider Demographics
NPI:1205084241
Name:ADVANCED SPINAL THERAPY AND CHIROPRACTIC CARE, PLLC
Entity type:Organization
Organization Name:ADVANCED SPINAL THERAPY AND CHIROPRACTIC CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MCKEOWN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-747-9200
Mailing Address - Street 1:879 COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:THORNWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10594-1415
Mailing Address - Country:US
Mailing Address - Phone:914-747-9200
Mailing Address - Fax:914-747-4406
Practice Address - Street 1:879 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:THORNWOOD
Practice Address - State:NY
Practice Address - Zip Code:10594-1415
Practice Address - Country:US
Practice Address - Phone:914-747-9200
Practice Address - Fax:914-747-4406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010814111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6503150001OtherPTAN