Organization
BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY PC
Active
Organization
BROOKLYN CHIROPRACTIC SPINE & SPORTS INJURY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS J. BONACUSO JR. D.C.; CCSP (PRESIDENT)
(212) 486-8616
Entity
Organization
Contact information
Practice address
570 LEXINGTON AVE, SUITE 1903, NEW YORK, NY 10022-6837
(212) 486-8616
(212) 486-8621
Mailing address
570 LEXINGTON AVE, SUITE 1903, NEW YORK, NY 10022-6837
(212) 486-8616
(212) 486-8621
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
X005160
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03215818
—
NY
01
—
38MC00343400
NJ LICENSE
NJ
01
—
X005160
LICENSE
NY
Enumeration date
03/03/2008
Last updated
08/16/2013
Update your record
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