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General NPI Number Information
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NPI Number | 1912415845
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Entity Type | Organization
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Legal Business Name | TJB CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 01/12/2018
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Last Update Date | 01/12/2018
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Provider Practice Location Address
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Address Line | 10 HANOVER SQUARE
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City | NEW YORK
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State | NY
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Zip | 10005
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Country | US
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Telephone | 646-799-2010
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HANOVER SQUARE
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City | NEW YORK
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State | NY
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Zip | 10005
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Country | US
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Telephone | 646-799-2010
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Fax |
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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 | 646-799-2010
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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 |
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Taxonomy #2
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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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