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General NPI Number Information
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NPI Number | 1649598202
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Entity Type | Organization
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Legal Business Name | IN LINE CHIROPRACTIC PC
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Dates
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Enumeration Date | 05/06/2010
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Last Update Date | 05/06/2010
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Provider Practice Location Address
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Address Line | 135-06A JAMAICA AVE
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City | RICHMOND HILL
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State | NY
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Zip | 11419
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Country | US
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Telephone | 718-657-7773
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Fax |
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Provider Business Mailing Address
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Address Line | 7110 PARK AVE APT. 2V
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City | FRESH MEADOWS
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State | NY
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Zip | 11365-4106
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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 | PRESIDENT
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Name | MITCHELL C RUBIN
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Credential | D.C.
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Telephone | 516-233-6352
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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 | 011570
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License Number State | NY
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