MEDICARE: GO 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
1	111N00000X	Chiropractor	X012916	NY

General Provider Information

NPI Number	:	1821590498
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GO CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	2500 LEMOINE AVE STE 304
Second Line	:
City	:	FORT LEE
State	:	NJ
Zip	:	07024-6205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5037 BROADWAY FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10034-1131
Country	:	US
Telephone Number	:	917-528-0174
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	EUN JU KIM
Credential	:	DC
Telephone Number	:	917-528-0174

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	03/13/2018

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