Provider Demographics
NPI:1609926476
Name:THALROSE, MILO T (DC)
Entity type:Individual
Prefix:DR
First Name:MILO
Middle Name:T
Last Name:THALROSE
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 1:458 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2232
Mailing Address - Country:US
Mailing Address - Phone:516-486-2857
Mailing Address - Fax:
Practice Address - Street 1:458 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2232
Practice Address - Country:US
Practice Address - Phone:516-486-2857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004063-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0002538OtherGHI PROVIDER NUMBER
NYX23521Medicare ID - Type Unspecified