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General NPI Number Information
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NPI Number | 1497119465
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Entity Type | Organization
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Legal Business Name | CORDOVA CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/06/2016
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 6535 QUEENS BLVD SUITE 100
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City | WOODSIDE
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State | NY
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Zip | 11377-5769
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Country | US
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Telephone | 718-426-4242
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Fax |
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Provider Business Mailing Address
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Address Line | 3225 88TH ST APT 207
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City | EAST ELMHURST
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State | NY
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Zip | 11369-2147
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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 | DC
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Name | KATERINE RAYMONDI
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Credential |
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Telephone | 908-546-2816
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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 |
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License Number State |
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