Provider Demographics
NPI:1174169106
Name:WATER STREET CHIROPRACTIC PC
Entity type:Organization
Organization Name:WATER STREET CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-256-1171
Mailing Address - Street 1:1 NEW YORK PLZ STE L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10004-1901
Mailing Address - Country:US
Mailing Address - Phone:212-256-1171
Mailing Address - Fax:
Practice Address - Street 1:1 NEW YORK PLZ STE L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1901
Practice Address - Country:US
Practice Address - Phone:212-256-1171
Practice Address - Fax:212-256-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty