MEDICARE: BROAD AVE CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171100000X	Acupuncturist
2	225100000X	Physical Therapist
3	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1750990024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD AVE CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	669 BROAD AVE STE 204
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1631
Country	:	US
Telephone Number	:	201-917-3300
Fax Number	:	201-917-3302

Provider Business Practice Location Address
First Line	:	669 BROAD AVE STE 204
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1631
Country	:	US
Telephone Number	:	201-917-3300
Fax Number	:	201-917-3302

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HYUNIK HWANGBO
Credential	:	DC
Telephone Number	:	914-450-8881

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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Directions to “BROAD AVE CHIROPRACTIC LLC ” Practice Location

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