Basic Information
| Provider Information | |||||||||
| NPI: | 1548443021 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAJ III, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 MADISON AVE | ||||||||
| Address2: | SUITE 1906 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100225403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127526770 | ||||||||
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| Practice Location | |||||||||
| Address1: | 515 MADISON AVE | ||||||||
| Address2: | SUITE 1906 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100225403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2127526770 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2007 | ||||||||
| LastUpdateDate: | 12/07/2007 | ||||||||
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| AuthorizedOfficialLastName: | JOSEPH | ||||||||
| AuthorizedOfficialFirstName: | CRYSTAL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | APPLIED KINESIOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2127526770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C., AK, CCSP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NS0005X | XO008088 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Sports Physician |
No ID Information.