=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164770558
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARTHUR CHIROPRACTIC WELLNESS OF NEW YORK
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2012
-----------------------------------------------------
Last Update Date | 08/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 274 MADISON AVE RM 705
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-0701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-481-0400
-----------------------------------------------------
Fax | 631-481-9631
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 274 MADISON AVE RM 705
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10016-0701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-481-0400
-----------------------------------------------------
Fax | 631-481-9631
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ARTUR VITO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 212-481-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number | XO11833-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------