Provider Demographics
NPI:1497083752
Name:PLAZA CHIROPRACTIC HEALTHCARE P.C.
Entity Type:Organization
Organization Name:PLAZA CHIROPRACTIC HEALTHCARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:
Authorized Official - First Name:SAMUE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-359-3777
Mailing Address - Street 1:14225 37TH AVE.
Mailing Address - Street 2:C-2
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6531
Mailing Address - Country:US
Mailing Address - Phone:718-359-3777
Mailing Address - Fax:718-359-3770
Practice Address - Street 1:14225 37TH AVE.
Practice Address - Street 2:C-2
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-6531
Practice Address - Country:US
Practice Address - Phone:718-359-3777
Practice Address - Fax:718-359-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009870111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty