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NPI Code Detail

MEDICARE: BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY PC

MEDICARE: BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY 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
1111NS0005XSports Physician ChiropractorX005160NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
138MC00343400OTHERNJNJ LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3X005160OTHERNYLICENSE

General Provider Information

NPI Number : 1417127820
Entity Type Code : Organization
Provider Name (Legal Business Name) : BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY PC
Provider Business Mailing Address
First Line : 570 LEXINGTON AVE
Second Line : SUITE 1903
City : NEW YORK
State : NY
Zip : 10022-6837
Country : US
Telephone Number : 212-486-8616
Fax Number : 212-486-8621
Provider Business Practice Location Address
First Line : 570 LEXINGTON AVE
Second Line : SUITE 1903
City : NEW YORK
State : NY
Zip : 10022-6837
Country : US
Telephone Number : 212-486-8616
Fax Number : 212-486-8621
Authorized Official
Title or Position : PRESIDENT
Name : DR. THOMAS J. BONACUSO JR.
Credential : D.C.; CCSP
Telephone Number : 212-486-8616
Provider Enumeration Date : 03/03/2008
Last Update Date : 08/16/2013

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Directions to “BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY PC ” Practice Location

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