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General NPI Number Information
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NPI Number | 1740425198
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Entity Type | Organization
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Legal Business Name | VILLAGE CHIROPRACTIC
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Dates
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Enumeration Date | 12/12/2008
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 6133 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2739
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Country | US
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Telephone | 718-429-6630
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Fax | 718-429-6584
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Provider Business Mailing Address
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Address Line | 6133 WOODHAVEN BLVD
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City | REGO PARK
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State | NY
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Zip | 11374-2739
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Country | US
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Telephone | 718-429-6630
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Fax | 718-429-6584
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Authorized Official
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Title or Position | OWNER
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Name | FREDERICK GIOVANELLI
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Credential | D.C.
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Telephone | 718-429-6630
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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 | X007091-2
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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 | X007331-1
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License Number State | NY
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