MEDICARE: AK 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	:	1518267764
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AK CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	223 PICCADILLY DOWNS
Second Line	:
City	:	LYNBROOK
State	:	NY
Zip	:	11563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1218 NEPTUNE AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224
Country	:	US
Telephone Number	:	718-676-2191
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALEXANDER KHAVASH
Credential	:	D.C.
Telephone Number	:	917-414-9528

Provider Enumeration Date	:	10/21/2010
Last Update Date	:	10/21/2010

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