Provider Demographics
NPI:1336175470
Name:CAPITAL CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CAPITAL CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KRESHOVER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-597-2900
Mailing Address - Street 1:2367 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5007
Mailing Address - Country:US
Mailing Address - Phone:718-597-2900
Mailing Address - Fax:718-597-2902
Practice Address - Street 1:2367 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-5007
Practice Address - Country:US
Practice Address - Phone:718-597-2900
Practice Address - Fax:718-597-2902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008873111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7S151Medicare ID - Type UnspecifiedCHIROPRACTIC