Healthcare Provider Details

I. General information

NPI: 1417120296
Provider Name (Legal Business Name): BNN CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2008
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21522 91ST AVE
QUEENS VILLAGE NY
11428-1217
US

IV. Provider business mailing address

20820 34TH AVE
BAYSIDE NY
11361-1334
US

V. Phone/Fax

Practice location:
  • Phone: 718-217-0969
  • Fax: 718-217-8247
Mailing address:
  • Phone: 718-926-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX010471
License Number StateNY

VIII. Authorized Official

Name: MR. BINH NHU NGUYEN
Title or Position: PRESIDENT
Credential: D.C.
Phone: 718-926-7272