Healthcare Provider Details

I. General information

NPI: 1255274189
Provider Name (Legal Business Name): CLEAR CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 LOUIS NINE BLVD
BRONX NY
10459-1535
US

IV. Provider business mailing address

1320 LOUIS NINE BLVD
BRONX NY
10459-1535
US

V. Phone/Fax

Practice location:
  • Phone: 347-862-0003
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: JONGDUG PARK
Title or Position: PRESIDENT
Credential: DC
Phone: 917-830-5115