MEDICARE: NELSON CASTRO DC

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	X007629	NY

General Provider Information

NPI Number	:	1649208588
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NELSON CASTRO DC

Provider Business Mailing Address
First Line	:	3244 31ST ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-2630
Country	:	US
Telephone Number	:	718-956-6565
Fax Number	:	718-956-7463

Provider Business Practice Location Address
First Line	:	3244 31ST ST
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-2630
Country	:	US
Telephone Number	:	718-956-6565
Fax Number	:	718-956-7463

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	06/11/2008

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Directions to “ NELSON CASTRO DC” Practice Location

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