Healthcare Provider Details

I. General information

NPI: 1093853269
Provider Name (Legal Business Name): COMPREHENSIVE CHIROPRACTIC AND REHABILITATION P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 VOORHIES AVE LOWER LEVEL
BROOKLYN NY
11235-3994
US

IV. Provider business mailing address

1513 VOORHIES AVE LOWER LEVEL
BROOKLYN NY
11235-3994
US

V. Phone/Fax

Practice location:
  • Phone: 718-332-5617
  • Fax: 718-332-0448
Mailing address:
  • Phone: 718-332-5617
  • Fax: 718-332-0448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCO09080-5B
License Number StateNY

VIII. Authorized Official

Name: DR. XERXES OSHIDAR
Title or Position: PRESIDENT
Credential: DC
Phone: 718-332-5617