Provider Demographics
NPI:1154627446
Name:PARK AVENUE CHIROPRACTIC HEALTHCARE P.C.
Entity Type:Organization
Organization Name:PARK AVENUE CHIROPRACTIC HEALTHCARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:SAMUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-321-3962
Mailing Address - Street 1:14627 BEECH AVE
Mailing Address - Street 2:SUITE #1C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2172
Mailing Address - Country:US
Mailing Address - Phone:718-321-3962
Mailing Address - Fax:
Practice Address - Street 1:14627 BEECH AVE
Practice Address - Street 2:SUITE #1C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2172
Practice Address - Country:US
Practice Address - Phone:718-321-3962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty