MEDICARE: CHIROPRACTIC HEALTH, P.C.

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	X008265	NY

General Provider Information

NPI Number	:	1700330354
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC HEALTH, P.C.

Provider Business Mailing Address
First Line	:	16 SQUADRON BLVD STE 102
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5268
Country	:	US
Telephone Number	:	845-634-2225
Fax Number	:	845-634-2227

Provider Business Practice Location Address
First Line	:	16 SQUADRON BLVD STE 102
Second Line	:
City	:	NEW CITY
State	:	NY
Zip	:	10956-5268
Country	:	US
Telephone Number	:	845-634-2225
Fax Number	:	845-634-2227

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RANDOLPH J RUSSO
Credential	:	D.C.
Telephone Number	:	914-419-0172

Provider Enumeration Date	:	08/12/2016
Last Update Date	:	08/12/2016

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