Healthcare Provider Details

I. General information

NPI: 1053636647
Provider Name (Legal Business Name): STATEN ISLAND CHIROPRACTIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2548
US

IV. Provider business mailing address

2052 RICHMOND RD
STATEN ISLAND NY
10306-2548
US

V. Phone/Fax

Practice location:
  • Phone: 718-667-2190
  • Fax: 718-667-7279
Mailing address:
  • Phone: 718-667-2190
  • Fax: 718-667-7279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008612-1
License Number StateNY

VIII. Authorized Official

Name: JASON BRATTNER
Title or Position: OWNER
Credential: DC
Phone: 718-667-2190