Provider Demographics
NPI:1952996100
Name:SPINAL JOINT CHIROPRACTIC PC
Entity type:Organization
Organization Name:SPINAL JOINT CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOSEOK
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:240-328-2982
Mailing Address - Street 1:15015 41ST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4929
Mailing Address - Country:US
Mailing Address - Phone:718-886-0055
Mailing Address - Fax:
Practice Address - Street 1:15015 41ST AVE STE 2
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4929
Practice Address - Country:US
Practice Address - Phone:718-886-0055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty