MEDICARE: SOUTH BRONX 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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1225807688
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BRONX CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	500 MONMOUTH DR
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-5716
Country	:	US
Telephone Number	:	302-434-0101
Fax Number	:

Provider Business Practice Location Address
First Line	:	2017 WILLIAMSBRIDGE RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10461-1606
Country	:	US
Telephone Number	:	302-434-0101
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JONGHWI KIM
Credential	:	DC
Telephone Number	:	302-434-0101

Provider Enumeration Date	:	12/27/2023
Last Update Date	:	12/27/2023

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