# NEW YORK INJURY CHIROPRACTIC REHAB PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1295416618
- **Authorized official:** AVIANNE WAITHE DC (CHIROPRACTIC DOCTOR/AO)
- **Authorized official phone:** (443) 622-9429

## Contact information

- **Practice address:** 3723 72ND ST FL 1, JACKSON HEIGHTS, NY 11372-6126
- **Practice address phone:** (718) 255-1533
- **Mailing address:** 3723 72ND ST FL 1, JACKSON HEIGHTS, NY 11372-6126
- **Mailing address phone:** (443) 622-9429

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NR0400X | Rehabilitation Chiropractor | — | NULL | Yes |
| 111NR0400X | Rehabilitation Chiropractor | — | — | Yes |
| 111NX0800X | Orthopedic Chiropractor | — | NULL | — |
| 111NX0800X | Orthopedic Chiropractor | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 246ZE0600X | Electroneurodiagnostic Specialist/Technologist | — | NULL | — |
| 246ZE0600X | Electroneurodiagnostic Specialist/Technologist | — | — | — |
| 247200000X | Other Technician | — | NULL | — |
| 247200000X | Other Technician | — | — | — |

## Other

- **Enumeration date:** 07/27/2023
- **Last updated:** 09/15/2023