Provider Demographics
NPI:1649596966
Name:EDX CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:EDX CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SRULEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-776-9050
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-0216
Mailing Address - Country:US
Mailing Address - Phone:917-776-9050
Mailing Address - Fax:
Practice Address - Street 1:2565 E 17TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3515
Practice Address - Country:US
Practice Address - Phone:917-776-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007940111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty