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General NPI Number Information
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NPI Number | 1417127820
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Entity Type | Organization
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Legal Business Name | BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY PC
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 08/16/2013
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Provider Practice Location Address
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Address Line | 570 LEXINGTON AVE SUITE 1903
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City | NEW YORK
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State | NY
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Zip | 10022-6837
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Country | US
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Telephone | 212-486-8616
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Fax | 212-486-8621
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Provider Business Mailing Address
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Address Line | 570 LEXINGTON AVE SUITE 1903
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City | NEW YORK
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State | NY
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Zip | 10022-6837
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Country | US
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Telephone | 212-486-8616
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Fax | 212-486-8621
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS J. BONACUSO JR.
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Credential | D.C.; CCSP
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Telephone | 212-486-8616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | X005160
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License Number State | NY
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