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General NPI Number Information
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NPI Number | 1134984065
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Entity Type | Organization
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Legal Business Name | JACKSON HEIGHTS WELLNESS CHIRO P.C.
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Dates
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Enumeration Date | 02/20/2024
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Last Update Date | 02/20/2024
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Provider Practice Location Address
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Address Line | 3741 77TH ST FL 1
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-6629
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Country | US
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Telephone | 718-406-9588
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Fax | 718-799-1063
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Provider Business Mailing Address
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Address Line | PO BOX 720548
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-0548
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Country | US
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Telephone | 718-406-9588
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Fax | 718-799-1063
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CORAL ELCOCK
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Credential | DC
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Telephone | 718-406-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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