Provider Demographics
NPI: | 1528395688 |
---|---|
Name: | KAZU CHIROPRACTIC PC |
Entity Type: | Organization |
Organization Name: | KAZU CHIROPRACTIC PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JOSEPH |
Authorized Official - Middle Name: | J |
Authorized Official - Last Name: | LODESPOTO |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | CHIROPRACTOR |
Authorized Official - Phone: | 347-561-3120 |
Mailing Address - Street 1: | 80-27 135 STR |
Mailing Address - Street 2: | |
Mailing Address - City: | JAMAICA |
Mailing Address - State: | NY |
Mailing Address - Zip Code: | 11435-1029 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 347-561-3120 |
Mailing Address - Fax: | 347-561-3142 |
Practice Address - Street 1: | 80-27 135 STR |
Practice Address - Street 2: | |
Practice Address - City: | JAMAICA |
Practice Address - State: | NY |
Practice Address - Zip Code: | 11435-1029 |
Practice Address - Country: | US |
Practice Address - Phone: | 347-561-3120 |
Practice Address - Fax: | 347-561-3142 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | YES |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2009-11-11 |
Last Update Date: | 2009-11-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NY | X010708 | 261QC1800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QC1800X | Ambulatory Health Care Facilities | Clinic/Center | Corporate Health |