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General NPI Number Information
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NPI Number | 1205094067
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Entity Type | Organization
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Legal Business Name | S A HEALTHY BODY CHIROPRACTIC
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Dates
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Enumeration Date | 05/29/2008
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Last Update Date | 05/29/2008
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Provider Practice Location Address
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Address Line | 271 KELLY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6008
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Country | US
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Telephone | 718-698-5600
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Fax | 718-698-5668
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Provider Business Mailing Address
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Address Line | 271 KELLY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-6008
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Country | US
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Telephone | 718-698-5600
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Fax | 718-698-5668
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Authorized Official
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Title or Position | PRESIDENT CHIROPRACTOR
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Name | MR. STEVEN W ALBERT JR.
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Credential | DC
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Telephone | 718-698-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X008514
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License Number State | NY
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