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General NPI Number Information
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NPI Number | 1871962258
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Entity Type | Organization
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Legal Business Name | PARK PLACE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 109 ECHO AVE
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City | MILLER PLACE
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State | NY
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Zip | 11764-2205
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Country | US
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Telephone | 631-331-5353
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Fax | 631-331-3948
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Provider Business Mailing Address
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Address Line | 109 ECHO AVE
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City | MILLER PLACE
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State | NY
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Zip | 11764-2205
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Country | US
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Telephone | 631-331-5353
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Fax | 631-331-3948
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Authorized Official
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Title or Position | OWNER
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Name | DR. JESSE ELSHOLZ
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Credential | D.C.
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Telephone | 631-331-5353
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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 | X011327
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License Number State | NY
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