Provider Demographics
NPI:1306085774
Name:BORO CHIROPRACTIC PC
Entity type:Organization
Organization Name:BORO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEBSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-802-2476
Mailing Address - Street 1:4 MORRIS CT
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-1825
Mailing Address - Country:US
Mailing Address - Phone:516-802-2476
Mailing Address - Fax:516-422-5386
Practice Address - Street 1:3808 14TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-3610
Practice Address - Country:US
Practice Address - Phone:718-972-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008647111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty