Provider Demographics
NPI:1003969296
Name:BAE CHIROPRACTIC P.C
Entity Type:Organization
Organization Name:BAE CHIROPRACTIC P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAK-SOO
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-445-6477
Mailing Address - Street 1:3125 UNION ST
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-2346
Mailing Address - Country:US
Mailing Address - Phone:718-445-6477
Mailing Address - Fax:718-445-6933
Practice Address - Street 1:3125 UNION ST
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-2346
Practice Address - Country:US
Practice Address - Phone:718-445-6477
Practice Address - Fax:718-445-6933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty