Provider Demographics
NPI:1487873519
Name:AVENUE T CHIROPRACTIC, PC
Entity type:Organization
Organization Name:AVENUE T CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:SETH
Authorized Official - Last Name:HURWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-266-8100
Mailing Address - Street 1:152 AVENUE T
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-3631
Mailing Address - Country:US
Mailing Address - Phone:718-266-8100
Mailing Address - Fax:718-266-0854
Practice Address - Street 1:152 AVENUE T
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-3631
Practice Address - Country:US
Practice Address - Phone:718-266-8100
Practice Address - Fax:718-266-0854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009834111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4V363OtherBC/BS
NYY51375Medicare UPIN
NYX4V363OtherBC/BS