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General NPI Number Information
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NPI Number | 1134767833
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Entity Type | Organization
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Legal Business Name | QUEENS BOULEVARD CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 51-27 QUEENS BLVD 2ND FL 2C
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City | WOODSIDE
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State | NY
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Zip | 11377
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Country | US
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Telephone | 929-463-3049
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Fax | 929-463-3421
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Provider Business Mailing Address
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Address Line | 7217 34TH AVE APT 1E
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-1023
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Country | US
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Telephone | 917-704-1978
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIO DUQUE
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Credential | DC
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Telephone | 917-704-1978
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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 |
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License Number State |
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