Provider Demographics
NPI:1750990024
Name:BROAD AVE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:BROAD AVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HYUNIK
Authorized Official - Middle Name:
Authorized Official - Last Name:HWANGBO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:914-450-8881
Mailing Address - Street 1:669 BROAD AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1631
Mailing Address - Country:US
Mailing Address - Phone:201-917-3300
Mailing Address - Fax:201-917-3302
Practice Address - Street 1:669 BROAD AVE STE 204
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1631
Practice Address - Country:US
Practice Address - Phone:201-917-3300
Practice Address - Fax:201-917-3302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty