Provider Demographics
NPI:1659096733
Name:SPINE HEALTH CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SPINE HEALTH CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-640-6860
Mailing Address - Street 1:14935 NORTHERN BLVD APT 5F
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3834
Mailing Address - Country:US
Mailing Address - Phone:718-640-6860
Mailing Address - Fax:
Practice Address - Street 1:16410 CROCHERON AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-2016
Practice Address - Country:US
Practice Address - Phone:718-445-6272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty