=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255847695
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BKLYN CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2017
-----------------------------------------------------
Last Update Date | 12/21/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20935 NORTHERN BLVD
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11361-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-225-9000
-----------------------------------------------------
Fax | 718-352-9000
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3313 CLARENDON RD
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11203-4901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMEL ROMEO
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 716-316-0998
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 012404
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------