Provider Demographics
NPI:1629523055
Name:CHIROPRACTIC AND FAMILY ALTERNATIVE HEALTH FACILITY TRUST
Entity Type:Organization
Organization Name:CHIROPRACTIC AND FAMILY ALTERNATIVE HEALTH FACILITY TRUST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:HAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-984-5869
Mailing Address - Street 1:3676 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3835
Mailing Address - Country:US
Mailing Address - Phone:718-984-5869
Mailing Address - Fax:718-984-5583
Practice Address - Street 1:3676 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-3835
Practice Address - Country:US
Practice Address - Phone:718-984-5869
Practice Address - Fax:718-984-5583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-002011261QH0100X
NY003791-1261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service