Healthcare Provider Details

I. General information

NPI: 1790844504
Provider Name (Legal Business Name): LOUIS THOMAS CALVANO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2006
Last Update Date: 10/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 PARK AVE S FRONT 2
NEW YORK NY
10016-6819
US

IV. Provider business mailing address

470 PARK AVE S FRONT 2
NEW YORK NY
10016-6819
US

V. Phone/Fax

Practice location:
  • Phone: 212-369-5490
  • Fax: 212-685-6605
Mailing address:
  • Phone: 212-369-5490
  • Fax: 212-685-6605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX004585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: