MEDICARE: CHIROPRACTIC QUALITY 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	111N00000X	Chiropractor	X010911	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X010911	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1568801736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC QUALITY CARE PC

Provider Business Mailing Address
First Line	:	2741 E 28TH ST
Second Line	:	APT 6J
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2453
Country	:	US
Telephone Number	:	718-812-0569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 E 28TH ST
Second Line	:	APT 6J
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2453
Country	:	US
Telephone Number	:	718-812-0569
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERNEST BUBERMAN
Credential	:	DC
Telephone Number	:	718-812-0569

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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