Provider Demographics
NPI:1922332329
Name:QUEENS CENTER CHIROPRACTIC PC
Entity Type:Organization
Organization Name:QUEENS CENTER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EMANUEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:TSOUROUNAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-507-5581
Mailing Address - Street 1:9131 QUEENS BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5501
Mailing Address - Country:US
Mailing Address - Phone:718-507-5581
Mailing Address - Fax:
Practice Address - Street 1:9131 QUEENS BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5501
Practice Address - Country:US
Practice Address - Phone:718-507-5581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-01
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2885111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY75523Medicare PIN
NYT32082Medicare UPIN