Healthcare Provider Details

I. General information

NPI: 1003511429
Provider Name (Legal Business Name): FIDI CHIROPRACTIC WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 JOHN ST STE 1460
NEW YORK NY
10038-3136
US

IV. Provider business mailing address

111 JOHN ST STE 1460
NEW YORK NY
10038-3136
US

V. Phone/Fax

Practice location:
  • Phone: 646-509-0759
  • Fax:
Mailing address:
  • Phone: 646-509-0759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: PAULINA GIRALDO
Title or Position: OWNER
Credential:
Phone: 917-514-1299