Basic Information
| Provider Information | |||||||||
| NPI: | 1205563368 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | C S & J 1297 CHIRO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1297 CLOVE RD | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103014322 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188166500 | ||||||||
| FaxNumber: | 7188164677 | ||||||||
| Practice Location | |||||||||
| Address1: | 456 ARLENE ST | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103143814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188166500 | ||||||||
| FaxNumber: | 7188164677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/08/2022 | ||||||||
| LastUpdateDate: | 08/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNYDER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWENER | ||||||||
| AuthorizedOfficialTelephone: | 7188166500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.