Healthcare Provider Details

I. General information

NPI: 1619743762
Provider Name (Legal Business Name): JIS CHIROPRACTIC & ACUPUNCTURE P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2023
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 W 38TH ST RM 208
NEW YORK NY
10018-8425
US

IV. Provider business mailing address

330 W 38TH ST RM 208
NEW YORK NY
10018-8425
US

V. Phone/Fax

Practice location:
  • Phone: 929-702-4763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JI HOON KIM
Title or Position: CEO
Credential: DC, L.AC
Phone: 929-702-4763