MEDICARE: PERLINE CHIROPRACTIC, PC

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	X0100851	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X6V56	OTHER	NY	EMPIRE BC BS

General Provider Information

NPI Number	:	1144360504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERLINE CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	920 3RD AVE
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10022-3627
Country	:	US
Telephone Number	:	212-371-0700
Fax Number	:	212-750-9114

Provider Business Practice Location Address
First Line	:	920 3RD AVE
Second Line	:	6TH FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	10022-3627
Country	:	US
Telephone Number	:	212-371-0700
Fax Number	:	212-750-9114

Authorized Official
Title or Position	:	OWNER
Name	:	MS. SHELLEY BROOK PERLINE
Credential	:	D.C.
Telephone Number	:	212-371-0700

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/05/2016

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