Provider Demographics
NPI:1396985065
Name:UNIQUE CHIROPRACTIC PC
Entity type:Organization
Organization Name:UNIQUE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAVIKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:212-791-3399
Mailing Address - Street 1:1 MAIDEN LN FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-5130
Mailing Address - Country:US
Mailing Address - Phone:212-791-3399
Mailing Address - Fax:212-791-3388
Practice Address - Street 1:1 MAIDEN LN FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-5130
Practice Address - Country:US
Practice Address - Phone:212-791-3399
Practice Address - Fax:212-791-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009246261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5807933OtherGHI
NYC09246-2OtherWORKER COMPENSATION
NYNY09246OtherLANDMARK & HEALTH NET
NY5807933OtherGHI