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General NPI Number Information
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NPI Number | 1265977722
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Entity Type | Organization
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Legal Business Name | FRIENDS CHIROPRACTIC PC
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Dates
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Enumeration Date | 12/19/2016
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 20019 46TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11361
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Country | US
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Telephone | 212-302-2692
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Fax |
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Provider Business Mailing Address
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Address Line | 20019 46TH AVE
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City | BAYSIDE
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State | NY
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Zip | 11361-3018
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Country | US
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Telephone | 212-302-2692
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SOOYEON GIM
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Credential | DC
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Telephone | 347-653-2497
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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 | 012702
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License Number State | NY
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