Healthcare Provider Details

I. General information

NPI: 1952814543
Provider Name (Legal Business Name): SPINAL HEALTH CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2488 GRAND CONCOURSE STE 425
BRONX NY
10458-5203
US

IV. Provider business mailing address

275 STATE ST APT 5D
HACKENSACK NJ
07601-5539
US

V. Phone/Fax

Practice location:
  • Phone: 718-269-9433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: RUMMEL MENDOZA
Title or Position: PRESIDENT
Credential: DC
Phone: 718-269-9433