Provider Demographics
NPI:1902220346
Name:NEO-HEALTHCARE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:NEO-HEALTHCARE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC,MS
Authorized Official - Phone:203-906-5716
Mailing Address - Street 1:850 7TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:850 7TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-5230
Practice Address - Country:US
Practice Address - Phone:203-906-5716
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012410261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center