Provider Demographics
NPI:1285836981
Name:CORONA FAMILY CHIROPRACTIC CARE, PC
Entity Type:Organization
Organization Name:CORONA FAMILY CHIROPRACTIC CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-205-2230
Mailing Address - Street 1:4109 108TH ST
Mailing Address - Street 2:SUITE LL
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2355
Mailing Address - Country:US
Mailing Address - Phone:718-205-2245
Mailing Address - Fax:
Practice Address - Street 1:4109 108TH ST
Practice Address - Street 2:SUITE LL
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2355
Practice Address - Country:US
Practice Address - Phone:718-205-2245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008858111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6A231Medicare ID - Type Unspecified
NYU07283Medicare UPIN