Healthcare Provider Details

I. General information

NPI: 1346584265
Provider Name (Legal Business Name): SPINEALIGN CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 LEXINGTON AVE
NEW YORK NY
10065-7601
US

IV. Provider business mailing address

1173A 2ND AVE SUITE 107
NEW YORK NY
10065-8277
US

V. Phone/Fax

Practice location:
  • Phone: 917-263-0969
  • Fax:
Mailing address:
  • Phone: 917-263-0969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH CUCCI
Title or Position: CEO
Credential: D.C.
Phone: 917-263-0969