Healthcare Provider Details

I. General information

NPI: 1831452473
Provider Name (Legal Business Name): INTEGRAL PERFORMANCE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 06/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 DONGAN HILLS AVE SUITE 1E
STATEN ISLAND NY
10305-1246
US

IV. Provider business mailing address

235 DONGAN HILLS AVE SUITE 1E
STATEN ISLAND NY
10305-1246
US

V. Phone/Fax

Practice location:
  • Phone: 718-351-5400
  • Fax: 718-351-5433
Mailing address:
  • Phone: 718-351-5400
  • Fax: 718-351-5433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number70 011933
License Number StateNY

VIII. Authorized Official

Name: ALEX KAZHDAN
Title or Position: OWNER
Credential: DC
Phone: 718-351-5400