Provider Demographics
NPI:1093586182
Name:JACKSON HEIGHTS TOTAL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:JACKSON HEIGHTS TOTAL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-304-3316
Mailing Address - Street 1:8211 37TH AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7015
Mailing Address - Country:US
Mailing Address - Phone:718-440-9711
Mailing Address - Fax:
Practice Address - Street 1:8211 37TH AVE STE 602
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7015
Practice Address - Country:US
Practice Address - Phone:718-440-9711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty