Provider Demographics
NPI:1134984065
Name:JACKSON HEIGHTS WELLNESS CHIRO P.C.
Entity type:Organization
Organization Name:JACKSON HEIGHTS WELLNESS CHIRO P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ELCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-406-9588
Mailing Address - Street 1:PO BOX 720548
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-0548
Mailing Address - Country:US
Mailing Address - Phone:718-406-9588
Mailing Address - Fax:718-799-1063
Practice Address - Street 1:3741 77TH ST FL 1
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6629
Practice Address - Country:US
Practice Address - Phone:718-406-9588
Practice Address - Fax:718-799-1063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center