Healthcare Provider Details

I. General information

NPI: 1336877273
Provider Name (Legal Business Name): GEORGE TAISHIN DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 JACQUES AVE
STATEN ISLAND NY
10306-3029
US

IV. Provider business mailing address

173 JACQUES AVE
STATEN ISLAND NY
10306-3029
US

V. Phone/Fax

Practice location:
  • Phone: 718-766-7136
  • Fax:
Mailing address:
  • Phone: 718-766-7136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number013638
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number013638
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number013638
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number013638
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number013638
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number013638
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: