Provider Demographics
NPI:1124457908
Name:WEST SIDE CHIROPRACTIC AND SPINAL REHABILITATION PLLC
Entity type:Organization
Organization Name:WEST SIDE CHIROPRACTIC AND SPINAL REHABILITATION PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:A
Authorized Official - Last Name:LESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-664-0425
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-0547
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 WEST 83RD ST # 1048
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-1221
Practice Address - Country:US
Practice Address - Phone:917-664-0425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty