MEDICARE: BORO CHIROPRACTIC 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	X008647	NY

General Provider Information

NPI Number	:	1306085774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORO CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	4 MORRIS CT
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-1825
Country	:	US
Telephone Number	:	516-802-2476
Fax Number	:	516-422-5386

Provider Business Practice Location Address
First Line	:	3808 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-3610
Country	:	US
Telephone Number	:	718-972-4004
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. TODD L LEBSON
Credential	:	DC
Telephone Number	:	516-802-2476

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	02/09/2009

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