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General NPI Number Information
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NPI Number | 1497083752
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Entity Type | Organization
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Legal Business Name | PLAZA CHIROPRACTIC HEALTHCARE P.C.
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Dates
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Enumeration Date | 11/25/2009
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Last Update Date | 11/25/2009
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Provider Practice Location Address
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Address Line | 14225 37TH AVE. C-2
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City | FLUSHING
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State | NY
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Zip | 11354-6531
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Country | US
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Telephone | 718-359-3777
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Fax | 718-359-3770
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Provider Business Mailing Address
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Address Line | 14225 37TH AVE. C-2
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City | FLUSHING
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State | NY
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Zip | 11354-6531
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Country | US
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Telephone | 718-359-3777
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Fax | 718-359-3770
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Authorized Official
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Title or Position | D.C.
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Name | SAMUE C PARK
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Credential |
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Telephone | 718-359-3777
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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 | X009870
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License Number State | NY
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