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NPI Code Detail

MEDICARE: WALL STREET WELLNESS CHIROPRACTIC P.C.

MEDICARE: WALL STREET WELLNESS CHIROPRACTIC P.C.
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
1111N00000XChiropractor

General Provider Information

NPI Number : 1154132900
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALL STREET WELLNESS CHIROPRACTIC P.C.
Provider Business Mailing Address
First Line : 42 BROADWAY STE 1219
Second Line :
City : NEW YORK
State : NY
Zip : 10004-3834
Country : US
Telephone Number : 929-412-2654
Fax Number :
Provider Business Practice Location Address
First Line : 42 BROADWAY STE 1219
Second Line :
City : NEW YORK
State : NY
Zip : 10004-3834
Country : US
Telephone Number : 929-412-2654
Fax Number :
Authorized Official
Title or Position : CHIROPRACTOR
Name : JAESUNG PARK
Credential :
Telephone Number : 475-988-7695
Provider Enumeration Date : 01/20/2025
Last Update Date : 01/20/2025

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Directions to “WALL STREET WELLNESS CHIROPRACTIC P.C. ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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