Provider Demographics
NPI:1730613191
Name:BAY RIDGE CHIROPRACTIC, PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BAY RIDGE CHIROPRACTIC, PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANDARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-748-9624
Mailing Address - Street 1:9705 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-7702
Mailing Address - Country:US
Mailing Address - Phone:718-748-9624
Mailing Address - Fax:
Practice Address - Street 1:9705 3RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-7702
Practice Address - Country:US
Practice Address - Phone:718-748-9624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006608111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty