=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518173707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMFORT ZONE CHIROPRACTIC, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 142-01 37TH AVE.
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-358-6676
-----------------------------------------------------
Fax | 718-358-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 142-01 37TH AVE.
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-358-6676
-----------------------------------------------------
Fax | 718-358-6433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | DR. SAMUE C. PARK
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 718-358-6676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X009870
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------