Provider Demographics
NPI:1205233632
Name:CHIROPRACTIC DIAGNOSTIC TESTING
Entity type:Organization
Organization Name:CHIROPRACTIC DIAGNOSTIC TESTING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CHAIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-964-2000
Mailing Address - Street 1:2005 MERRICK RD
Mailing Address - Street 2:SUITE 269
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-4644
Mailing Address - Country:US
Mailing Address - Phone:212-964-2000
Mailing Address - Fax:
Practice Address - Street 1:2005 MERRICK RD
Practice Address - Street 2:SUITE 269
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-4644
Practice Address - Country:US
Practice Address - Phone:212-964-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006013-1261QR0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile