MEDICARE: DR. CHRISTOPHER WAYRICH DC, OTR/L

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	111NS0005X	Sports Physician Chiropractor	X009749-1	NY
2	225X00000X	Occupational Therapist	017569-1	NY

General Provider Information

NPI Number	:	1316946239
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER WAYRICH DC, OTR/L

Provider Business Mailing Address
First Line	:	7 DEER LN
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2608
Country	:	US
Telephone Number	:	516-314-2891
Fax Number	:	516-342-1066

Provider Business Practice Location Address
First Line	:	7 DEER LN
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2608
Country	:	US
Telephone Number	:	516-314-2891
Fax Number	:	516-342-1066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	10/04/2012

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