Provider Demographics
NPI:1528464922
Name:BACK TO NORMAL CHIROPRACTIC, PC
Entity type:Organization
Organization Name:BACK TO NORMAL CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:AVRIL
Authorized Official - Last Name:VILAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-456-2951
Mailing Address - Street 1:5 SAINT CHARLES PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2305 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3231
Practice Address - Country:US
Practice Address - Phone:917-456-2951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010054111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
33OtherCHIROPRACTIC