Provider Demographics
NPI:1518126366
Name:PROSPERITY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:PROSPERITY CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-960-7774
Mailing Address - Street 1:8915 PARSONS BLVD
Mailing Address - Street 2:SUITE 1G
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-6005
Mailing Address - Country:US
Mailing Address - Phone:347-960-7774
Mailing Address - Fax:347-960-8799
Practice Address - Street 1:8915 PARSONS BLVD
Practice Address - Street 2:SUITE 1G
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-6005
Practice Address - Country:US
Practice Address - Phone:347-960-7774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ38MC00668000OtherNEW JERSEY STATE LICENSE
GACHIR008311OtherGEORGIA STATE LICENSE