Provider Demographics
NPI:1285447755
Name:MK CHIROPRACTIC SERVICES PC
Entity type:Organization
Organization Name:MK CHIROPRACTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:KHODORKOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:347-831-7984
Mailing Address - Street 1:4398 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-4929
Mailing Address - Country:US
Mailing Address - Phone:347-313-8526
Mailing Address - Fax:
Practice Address - Street 1:81 PROSPECT ST STE 504
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3969
Practice Address - Country:US
Practice Address - Phone:347-313-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487430278OtherNPI