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General NPI Number Information
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NPI Number | 1215140058
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Entity Type | Organization
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Legal Business Name | CARE CHIROPRACTIC PC
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 24825 NORTHERN BLVD
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City | LITTLE NECK
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State | NY
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Zip | 11362-1280
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Country | US
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Telephone | 718-279-0110
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Fax | 718-279-0127
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Provider Business Mailing Address
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Address Line | 24825 NORTHERN BLVD
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City | LITTLE NECK
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State | NY
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Zip | 11362-1280
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Country | US
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Telephone | 718-279-0110
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Fax | 718-279-0127
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Authorized Official
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Title or Position | CEO
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Name | DR. MARK L JACOBS
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Credential | D.C.
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Telephone | 718-279-0110
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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 | X008202
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License Number State | NY
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