Provider Demographics
NPI:1417177676
Name:PLAZA CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:PLAZA CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:WALDEMAR
Authorized Official - Last Name:PAEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-275-4141
Mailing Address - Street 1:6332 99TH ST
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1941
Mailing Address - Country:US
Mailing Address - Phone:718-275-4141
Mailing Address - Fax:718-275-1805
Practice Address - Street 1:63-32 99TH ST
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1941
Practice Address - Country:US
Practice Address - Phone:718-275-4141
Practice Address - Fax:718-275-1805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1528178035OtherNPI