Provider Demographics
NPI:1952727331
Name:R.E. CHIROPRACTIC SERVICES, PLLC
Entity Type:Organization
Organization Name:R.E. CHIROPRACTIC SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FREDRICK
Authorized Official - Last Name:EBBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MONICA KIM
Authorized Official - Phone:646-732-2758
Mailing Address - Street 1:6 JULIA CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11953-2652
Mailing Address - Country:US
Mailing Address - Phone:516-526-2793
Mailing Address - Fax:718-709-5913
Practice Address - Street 1:139-39 35TH AVE.
Practice Address - Street 2:SUITE CFB
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3500
Practice Address - Country:US
Practice Address - Phone:516-526-2793
Practice Address - Fax:718-709-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-10
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010189-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty