MEDICARE: BROADWAY CHIROPRACTIC ASSOCIATES

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	X008059	NY

General Provider Information

NPI Number	:	1871617407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROADWAY CHIROPRACTIC ASSOCIATES

Provider Business Mailing Address
First Line	:	61 BROADWAY
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10006-2701
Country	:	US
Telephone Number	:	212-747-0934
Fax Number	:	212-747-0939

Provider Business Practice Location Address
First Line	:	61 BROADWAY
Second Line	:	SUITE 900
City	:	NEW YORK
State	:	NY
Zip	:	10006-2701
Country	:	US
Telephone Number	:	212-747-0934
Fax Number	:	212-747-0939

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. SCOTT MARK
Credential	:	DC
Telephone Number	:	212-747-0934

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	08/22/2020

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