Provider Demographics
NPI:1295009702
Name:GOLDEN EARTH CHIROPRACTIC & ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:GOLDEN EARTH CHIROPRACTIC & ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONG
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-888-9900
Mailing Address - Street 1:156-09 NORTHERN BWLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-888-9900
Mailing Address - Fax:718-321-1459
Practice Address - Street 1:156-09 NORTHERN BWLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-888-9900
Practice Address - Fax:718-321-1459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty