MEDICARE: FLATBUSH 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	X009043	NY

General Provider Information

NPI Number	:	1538349378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLATBUSH CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	PO BOX 315
Second Line	:
City	:	BALDWIN
State	:	NY
Zip	:	11510-0315
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-2329
Country	:	US
Telephone Number	:	718-421-1705
Fax Number	:	718-421-1723

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT SUPER
Credential	:	DC
Telephone Number	:	718-421-1705

Provider Enumeration Date	:	11/09/2007
Last Update Date	:	11/09/2007

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