Provider Demographics
NPI:1861012718
Name:EAST BRIGHT CHIROPRACTIC PC
Entity Type:Organization
Organization Name:EAST BRIGHT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUN HYUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:929-214-3042
Mailing Address - Street 1:21519 39TH AVE UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2114
Mailing Address - Country:US
Mailing Address - Phone:929-214-3042
Mailing Address - Fax:
Practice Address - Street 1:21519 39TH AVE UNIT 3
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2114
Practice Address - Country:US
Practice Address - Phone:929-214-3042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-21
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty