=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063747418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE CHIROPRACTIC PLACE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2009
-----------------------------------------------------
Last Update Date | 10/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4005 68TH ST
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-651-4500
-----------------------------------------------------
Fax | 718-651-4514
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4005 68TH ST
-----------------------------------------------------
City | WOODSIDE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11377-3831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-651-4500
-----------------------------------------------------
Fax | 718-651-4514
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | D.C
-----------------------------------------------------
Name | DR. VINCENT J GEIGER
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 718-651-4500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302R00000X
-----------------------------------------------------
Taxonomy Name | Health Maintenance Organization
-----------------------------------------------------
License Number | 007634
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------