MEDICARE: STATEN ISLAND CHIROPRACTIC ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X008612-1	NY

General Provider Information

NPI Number	:	1053636647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATEN ISLAND CHIROPRACTIC ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	2052 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2548
Country	:	US
Telephone Number	:	718-667-2190
Fax Number	:	718-667-7279

Provider Business Practice Location Address
First Line	:	2052 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2548
Country	:	US
Telephone Number	:	718-667-2190
Fax Number	:	718-667-7279

Authorized Official
Title or Position	:	OWNER
Name	:	JASON BRATTNER
Credential	:	DC
Telephone Number	:	718-667-2190

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	04/07/2010

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