=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295179174
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALL ACCESS CHIROPRACTIC P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/23/2013
-----------------------------------------------------
Last Update Date | 04/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13102 LIBERTY AVE
-----------------------------------------------------
City | SOUTH RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11419-3124
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-444-7198
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 162 VILLAGE AVE
-----------------------------------------------------
City | ELMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11003-4238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-830-8671
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN PHILLIP ROSS
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 516-444-7198
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP3300X
-----------------------------------------------------
Taxonomy Name | Pain Clinic/Center
-----------------------------------------------------
License Number | 010025
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------