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General NPI Number Information
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NPI Number | 1316234917
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Entity Type | Organization
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Legal Business Name | YOUR TRUE CHIROPRACTIC PC
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Dates
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Enumeration Date | 07/02/2011
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Last Update Date | 07/02/2011
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Provider Practice Location Address
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Address Line | 4125 KISSENA BLVD STE 125
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City | FLUSHING
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State | NY
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Zip | 11355-3130
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Country | US
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Telephone | 718-886-3341
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Fax | 718-321-3334
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Provider Business Mailing Address
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Address Line | 4125 KISSENA BLVD STE 125
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City | FLUSHING
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State | NY
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Zip | 11355-3130
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Country | US
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Telephone | 718-886-3341
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Fax | 718-321-3334
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SANG HO PARK
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Credential | DC
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Telephone | 718-886-3341
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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 | 009838
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License Number State | NY
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