Provider Demographics
NPI:1730270174
Name:NATURAL LIFE CHIROPRACTIC CARE PC
Entity type:Organization
Organization Name:NATURAL LIFE CHIROPRACTIC CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PC
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCO
Authorized Official - Middle Name:AGOSTINO
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-961-7575
Mailing Address - Street 1:83 MONTGOMERY AVE
Mailing Address - Street 2:FLOOR 1
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5104
Mailing Address - Country:US
Mailing Address - Phone:914-961-7575
Mailing Address - Fax:914-961-8489
Practice Address - Street 1:83 MONTGOMERY AVE
Practice Address - Street 2:FLOOR 1
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5104
Practice Address - Country:US
Practice Address - Phone:914-961-7575
Practice Address - Fax:914-961-8489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0101671111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5940680001Medicare NSC