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General NPI Number Information
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NPI Number | 1972942704
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Entity Type | Organization
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Legal Business Name | PARK CHIROPRACTIC CLINIC, LLC
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Dates
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Enumeration Date | 06/14/2013
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Last Update Date | 01/13/2014
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Provider Practice Location Address
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Address Line | 464 HUDSON TERR. SUITE 204
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2514
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Country | US
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Telephone | 201-956-4146
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Fax | 201-894-5450
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Provider Business Mailing Address
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Address Line | 464 HUDSON TERR. SUITE 204
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City | ENGLEWOOD CLIFFS
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State | NJ
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Zip | 07632-2514
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Country | US
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Telephone | 201-956-4146
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Fax | 201-894-5450
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Authorized Official
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Title or Position | PRESIDENT
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Name | DUCKSOON PARK
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Credential | D.C.
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Telephone | 201-956-4146
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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 | 38MC00504100
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License Number State | NJ
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