Provider Demographics
NPI:1417565177
Name:PROGRESSIVE MOTION CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:PROGRESSIVE MOTION CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:862-777-1421
Mailing Address - Street 1:4196 GLEANE ST APT E5
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-2619
Mailing Address - Country:US
Mailing Address - Phone:917-392-0146
Mailing Address - Fax:
Practice Address - Street 1:10828 68TH DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2951
Practice Address - Country:US
Practice Address - Phone:862-777-1421
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty