Provider Demographics
NPI:1023141082
Name:ROMERO, JOHN DOUGLAS (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DOUGLAS
Last Name:ROMERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 GRAHAM AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-1204
Mailing Address - Country:US
Mailing Address - Phone:718-782-8159
Mailing Address - Fax:718-782-8178
Practice Address - Street 1:244 GRAHAM AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-1204
Practice Address - Country:US
Practice Address - Phone:718-782-8159
Practice Address - Fax:718-782-8178
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007488111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02682268Medicaid
U56159Medicare UPIN
NY02682268Medicaid