Provider Demographics
NPI:1417292301
Name:ROCKAWAY COMPLETE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:ROCKAWAY COMPLETE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HIGUERA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-475-0078
Mailing Address - Street 1:12 NORTHCOTE CRES
Mailing Address - Street 2:
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-1502
Mailing Address - Country:US
Mailing Address - Phone:347-475-0078
Mailing Address - Fax:347-480-5559
Practice Address - Street 1:9205 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11417-2428
Practice Address - Country:US
Practice Address - Phone:347-475-0078
Practice Address - Fax:347-480-5559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-03
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty