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General NPI Number Information
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NPI Number | 1003969296
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Entity Type | Organization
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Legal Business Name | BAE CHIROPRACTIC P.C
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 3125 UNION ST
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City | FLUSHING
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State | NY
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Zip | 11354-2346
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Country | US
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Telephone | 718-445-6477
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Fax | 718-445-6933
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Provider Business Mailing Address
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Address Line | 3125 UNION ST
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City | FLUSHING
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State | NY
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Zip | 11354-2346
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Country | US
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Telephone | 718-445-6477
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Fax | 718-445-6933
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Authorized Official
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Title or Position | PRESIDENT
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Name | HAK-SOO BAE
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Credential | D.C
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Telephone | 718-445-6477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X009086
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License Number State | NY
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