Provider Demographics
NPI:1720120231
Name:KWAN, JOSEPHINE P (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:P
Last Name:KWAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 CANAL ST
Mailing Address - Street 2:SUITE 516
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-6010
Mailing Address - Country:US
Mailing Address - Phone:212-219-8150
Mailing Address - Fax:212-219-8152
Practice Address - Street 1:265 CANAL ST
Practice Address - Street 2:SUITE 516
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-6010
Practice Address - Country:US
Practice Address - Phone:212-219-8150
Practice Address - Fax:212-219-8152
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3745111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX21811Medicare PIN