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General NPI Number Information
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NPI Number | 1447513668
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Entity Type | Organization
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Legal Business Name | ALPHA CHIROPRACTIC, PC
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 520 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3622
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Country | US
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Telephone | 718-327-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 520 BEACH 20TH ST
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City | FAR ROCKAWAY
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State | NY
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Zip | 11691-3622
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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 | DR. ANDREW SUSI
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Credential | DC
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Telephone | 718-327-5011
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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 | 008405
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License Number State | NY
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