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General NPI Number Information
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NPI Number | 1265658728
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Entity Type | Organization
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Legal Business Name | WOODHAVEN PARK CHIROPRACTIC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2 ROSES CT
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City | DIX HILLS
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State | NY
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Zip | 11746-4874
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Country | US
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Telephone | 631-462-0670
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Fax |
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Provider Business Mailing Address
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Address Line | 9309 91ST AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-2745
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY LATONA
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Credential |
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Telephone | 718-847-2326
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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 | X3747
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License Number State | NY
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