Provider Demographics
NPI:1740425198
Name:VILLAGE CHIROPRACTIC
Entity Type:Organization
Organization Name:VILLAGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:GIOVANELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-429-6630
Mailing Address - Street 1:6133 WOODHAVEN BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2739
Mailing Address - Country:US
Mailing Address - Phone:718-429-6630
Mailing Address - Fax:718-429-6584
Practice Address - Street 1:6133 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2739
Practice Address - Country:US
Practice Address - Phone:718-429-6630
Practice Address - Fax:718-429-6584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007331-1111N00000X
NYX007091-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty