Provider Demographics
NPI:1568735587
Name:ANDES CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:ANDES CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-661-1500
Mailing Address - Street 1:4021 159TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-1666
Mailing Address - Country:US
Mailing Address - Phone:718-661-1500
Mailing Address - Fax:718-661-1503
Practice Address - Street 1:4021 159TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-1666
Practice Address - Country:US
Practice Address - Phone:718-661-1500
Practice Address - Fax:718-661-1503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009105111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty