Healthcare Provider Details

I. General information

NPI: 1518102805
Provider Name (Legal Business Name): CHRIS GERARD BAUN CUETO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13704 GUY R BREWER BLVD
JAMAICA NY
11434-3731
US

IV. Provider business mailing address

13704 GUY R BREWER BLVD
JAMAICA NY
11434-3731
US

V. Phone/Fax

Practice location:
  • Phone: 516-606-7326
  • Fax:
Mailing address:
  • Phone: 516-606-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number011623
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number011623
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: