MEDICARE: CITY CHIROPRACTIC AND WELLNESS DOWNTOWN

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

General Provider Information

NPI Number	:	1669983052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY CHIROPRACTIC AND WELLNESS DOWNTOWN

Provider Business Mailing Address
First Line	:	1410 BROADWAY RM 202
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10018-9835
Country	:	US
Telephone Number	:	212-354-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 BROADWAY RM 1303
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10006-1936
Country	:	US
Telephone Number	:	646-216-3854
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JEFFREY KLEIN
Credential	:	DC
Telephone Number	:	917-204-6396

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/12/2017

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