Provider Demographics
NPI:1134773757
Name:EMPIRE CHIROPRACTIC
Entity type:Organization
Organization Name:EMPIRE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:LEZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-728-4899
Mailing Address - Street 1:8923 AVENUE A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-1206
Mailing Address - Country:US
Mailing Address - Phone:718-629-4020
Mailing Address - Fax:
Practice Address - Street 1:8923 AVENUE A
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-1206
Practice Address - Country:US
Practice Address - Phone:718-629-4020
Practice Address - Fax:718-629-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty