Healthcare Provider Details

I. General information

NPI: 1891662987
Provider Name (Legal Business Name): 1975 VICTORY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1975 VICTORY BLVD
STATEN ISLAND NY
10314-3553
US

IV. Provider business mailing address

1975 VICTORY BLVD
STATEN ISLAND NY
10314-3553
US

V. Phone/Fax

Practice location:
  • Phone: 718-203-8518
  • Fax: 718-223-5853
Mailing address:
  • Phone: 718-203-8518
  • Fax: 718-223-5853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARINA GADABORSHEV
Title or Position: CHIROPRACTOR/OWNER
Credential: DC
Phone: 973-519-6302