MEDICARE: NOVA CHIROPRACTIC SERVICES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1275937039
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA CHIROPRACTIC SERVICES PC

Provider Business Mailing Address
First Line	:	3009 45TH ST
Second Line	:	STE 2FT
City	:	ASTORIA
State	:	NY
Zip	:	11103-1848
Country	:	US
Telephone Number	:	914-419-3190
Fax Number	:	800-520-5573

Provider Business Practice Location Address
First Line	:	6860 AUSTIN ST
Second Line	:	SUITE 404
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4245
Country	:	US
Telephone Number	:	914-419-3190
Fax Number	:	800-520-5573

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT WATTON
Credential	:	DC
Telephone Number	:	914-419-3190

Provider Enumeration Date	:	10/22/2014
Last Update Date	:	10/22/2014

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