Healthcare Provider Details

I. General information

NPI: 1790087237
Provider Name (Legal Business Name): NEKTALOV FAMILY CHIROPRACTIC & PT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 UNION TPKE
FLUSHING NY
11367-3927
US

IV. Provider business mailing address

PO BOX 270
MASSAPEQUA PARK NY
11762-0270
US

V. Phone/Fax

Practice location:
  • Phone: 347-829-6322
  • Fax:
Mailing address:
  • Phone: 631-264-2035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011815
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. BORIS NEKTALOV
Title or Position: CHIROPRACTOR
Credential: DC
Phone: 347-829-6322