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General NPI Number Information
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NPI Number | 1346653813
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC PERFORMANCE SERVICE PC
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 8416 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-1920
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Country | US
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Telephone | 718-296-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 8416 JAMAICA AVE
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City | WOODHAVEN
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State | NY
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Zip | 11421-1920
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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 DESANO
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Credential |
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Telephone | 718-296-6900
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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 | X006997-1
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License Number State | NY
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