MEDICARE: ALPHA 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	008405	NY

General Provider Information

NPI Number	:	1447513668
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALPHA CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	520 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3622
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 BEACH 20TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-3622
Country	:	US
Telephone Number	:	718-327-5011
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ANDREW SUSI
Credential	:	DC
Telephone Number	:	718-327-5011

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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