Provider Demographics
NPI:1295445229
Name:BALDWIN INJURY CHIROPRACTIC PC
Entity type:Organization
Organization Name:BALDWIN INJURY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-652-3362
Mailing Address - Street 1:149 TWIN LN N
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-1943
Mailing Address - Country:US
Mailing Address - Phone:516-658-3362
Mailing Address - Fax:
Practice Address - Street 1:700 ROCKAWAY TPKE
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:NY
Practice Address - Zip Code:11559-1014
Practice Address - Country:US
Practice Address - Phone:516-612-4893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty