Provider Demographics
NPI:1720260870
Name:SHIRLEY CHIROPRACTIC CTR.
Entity Type:Organization
Organization Name:SHIRLEY CHIROPRACTIC CTR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-395-9090
Mailing Address - Street 1:2 CORACI BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-4833
Mailing Address - Country:US
Mailing Address - Phone:631-395-9090
Mailing Address - Fax:631-395-9100
Practice Address - Street 1:2 CORACI BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-4833
Practice Address - Country:US
Practice Address - Phone:631-395-9090
Practice Address - Fax:631-395-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWET791Medicare PIN