Provider Demographics
NPI:1316234917
Name:YOUR TRUE CHIROPRACTIC PC
Entity type:Organization
Organization Name:YOUR TRUE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANG
Authorized Official - Middle Name:HO
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-886-3341
Mailing Address - Street 1:4125 KISSENA BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3130
Mailing Address - Country:US
Mailing Address - Phone:718-886-3341
Mailing Address - Fax:718-321-3334
Practice Address - Street 1:4125 KISSENA BLVD STE 125
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3130
Practice Address - Country:US
Practice Address - Phone:718-886-3341
Practice Address - Fax:718-321-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-02
Last Update Date:2011-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009838111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1235164989OtherNPI