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General NPI Number Information
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NPI Number | 1235405051
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Entity Type | Organization
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Legal Business Name | S.P.E. CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 03/27/2012
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Last Update Date | 03/27/2012
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Provider Practice Location Address
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Address Line | 14040 QUEENS BLVD
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City | JAMAICA
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State | NY
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Zip | 11435-3220
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Country | US
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Telephone | 718-480-6794
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Fax | 718-480-6985
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Provider Business Mailing Address
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Address Line | 2180 HUGHES AVE
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City | BRONX
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State | NY
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Zip | 10457-1664
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Country | US
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Telephone | 646-229-2290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SWEET PRECIOUS EHIGIEGBA
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Credential | D. C.
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Telephone | 646-229-2290
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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 | 011734
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License Number State | NY
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