Provider Demographics
NPI:1508254178
Name:SPINE FIRST CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:SPINE FIRST CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-681-2110
Mailing Address - Street 1:615 SENECA AVE
Mailing Address - Street 2:GROUND FLOOR (MEDICAL CENTER)
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-2170
Mailing Address - Country:US
Mailing Address - Phone:718-497-9768
Mailing Address - Fax:
Practice Address - Street 1:615 SENECA AVE
Practice Address - Street 2:GROUND FLOOR (MEDICAL CENTER)
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-2170
Practice Address - Country:US
Practice Address - Phone:718-497-9768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-05
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0120581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty