Provider Demographics
NPI:1053434860
Name:PRAKASH, ANKUR (DC)
Entity type:Individual
Prefix:DR
First Name:ANKUR
Middle Name:
Last Name:PRAKASH
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 1:4600 LAKE BOONE TRL
Mailing Address - Street 2:STE 210
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7529
Mailing Address - Country:US
Mailing Address - Phone:919-926-8890
Mailing Address - Fax:
Practice Address - Street 1:113 W 78TH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-6755
Practice Address - Country:US
Practice Address - Phone:212-579-2858
Practice Address - Fax:212-579-2853
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010915111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7N041Medicare ID - Type Unspecified