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General NPI Number Information
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NPI Number | 1528596624
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Entity Type | Organization
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Legal Business Name | SPINE CARE CHIROPRACTIC, PC
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 9701 101ST AVE
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City | OZONE PARK
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State | NY
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Zip | 11416-2523
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Country | US
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Telephone | 718-835-4199
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 LEMOINE AVE STE 303
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City | FORT LEE
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State | NJ
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Zip | 07024-6205
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Country | US
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Telephone | 291-363-0233
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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. JAE CHUNG
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Credential | DC
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Telephone | 718-835-4199
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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 | 012920
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 012520
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License Number State | NY
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