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NPI Code Detail

MEDICARE: SEA CLIFF CHIROPRACTIC OFFICE PC

MEDICARE: SEA CLIFF CHIROPRACTIC OFFICE PC
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
1111N00000XChiropractor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1T52221OTHERNYUPIN

General Provider Information

NPI Number : 1407925365
Entity Type Code : Organization
Provider Name (Legal Business Name) : SEA CLIFF CHIROPRACTIC OFFICE PC
Provider Business Mailing Address
First Line : 70 GLEN ST
Second Line : SUITE 380
City : GLEN COVE
State : NY
Zip : 11542-2855
Country : US
Telephone Number : 516-759-2424
Fax Number : 516-759-6627
Provider Business Practice Location Address
First Line : 70 GLEN ST
Second Line : SUITE 380
City : GLEN COVE
State : NY
Zip : 11542-2858
Country : US
Telephone Number : 516-759-2424
Fax Number : 516-759-6627
Authorized Official
Title or Position : CHIROPRACTOR
Name : DR. PETER MUNDA
Credential : CH
Telephone Number : 516-759-2424
Provider Enumeration Date : 11/07/2006
Last Update Date : 11/07/2007

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Directions to “SEA CLIFF CHIROPRACTIC OFFICE PC ” Practice Location

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