=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568616845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HYUNIK HWANGBO D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2008
-----------------------------------------------------
Last Update Date | 12/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150-15 41ST AVE. #3D
-----------------------------------------------------
City | FLUSHING
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11354
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-321-8522
-----------------------------------------------------
Fax | 718-321-8524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 RIDGE RD B
-----------------------------------------------------
City | DOBBS FERRY
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10522-3303
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-885-0011
-----------------------------------------------------
Fax | 203-325-3305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X011383
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 001699
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------