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General NPI Number Information
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NPI Number | 1508311135
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Entity Type | Organization
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Legal Business Name | NEW YORK CORE CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 08/24/2016
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Last Update Date | 06/15/2020
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Provider Practice Location Address
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Address Line | 20935 NORTHERN BLVD STE 209A
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City | BAYSIDE
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State | NY
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Zip | 11361-3134
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Country | US
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Telephone | 718-577-8933
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Fax |
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Provider Business Mailing Address
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Address Line | 20810 CROSS ISLAND PKWY # 528
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City | BAYSIDE
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State | NY
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Zip | 11360-1187
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Country | US
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Telephone | 718-577-8933
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | IVAN LAM
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Credential | D.C.
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Telephone | 718-577-8933
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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 | X012540-1
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License Number State | NY
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