MEDICARE: HAVEN CHIROPRACTIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0800X	Orthopedic Chiropractor	X007296	NY

General Provider Information

NPI Number	:	1073536058
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAVEN CHIROPRACTIC, PC

Provider Business Mailing Address
First Line	:	3743 76TH ST
Second Line	:	SUITE 3
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6533
Country	:	US
Telephone Number	:	347-448-5185
Fax Number	:

Provider Business Practice Location Address
First Line	:	3743 76TH ST
Second Line	:	SUITE 3
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6533
Country	:	US
Telephone Number	:	347-448-5185
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY EMANUEL BUZZELL
Credential	:	DC
Telephone Number	:	347-448-5185

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/14/2008

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