MEDICARE: PARK SLOPE CHIROPRACTIC THERAPY REHABILITATION CARE 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	111NR0400X	Rehabilitation Chiropractor	009347	NY

General Provider Information

NPI Number	:	1215273701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK SLOPE CHIROPRACTIC THERAPY REHABILITATION CARE PC

Provider Business Mailing Address
First Line	:	790A UNION ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1307
Country	:	US
Telephone Number	:	718-230-4842
Fax Number	:	718-230-4834

Provider Business Practice Location Address
First Line	:	790A UNION ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1307
Country	:	US
Telephone Number	:	718-230-4842
Fax Number	:	718-230-4834

Authorized Official
Title or Position	:	OWNER
Name	:	MR. KEITH WILLIAMS
Credential	:	D.C
Telephone Number	:	718-230-4842

Provider Enumeration Date	:	01/02/2013
Last Update Date	:	01/02/2013

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