Provider Demographics
NPI:1134767833
Name:QUEENS BOULEVARD CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:QUEENS BOULEVARD CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DUQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:917-704-1978
Mailing Address - Street 1:7217 34TH AVE APT 1E
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-1023
Mailing Address - Country:US
Mailing Address - Phone:917-704-1978
Mailing Address - Fax:
Practice Address - Street 1:51-27 QUEENS BLVD
Practice Address - Street 2:2ND FL 2C
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377
Practice Address - Country:US
Practice Address - Phone:929-463-3049
Practice Address - Fax:929-463-3421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty