Healthcare Provider Details

I. General information

NPI: 1376729160
Provider Name (Legal Business Name): ROCKAWAY FAMILY CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 09/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12910 NEWPORT AVE
BELLE HARBOR NY
11694-1617
US

IV. Provider business mailing address

12910 NEWPORT AVE
BELLE HARBOR NY
11694-1617
US

V. Phone/Fax

Practice location:
  • Phone: 718-634-4800
  • Fax: 718-474-0735
Mailing address:
  • Phone: 718-634-4800
  • Fax: 718-474-0735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008394-1
License Number StateNY

VIII. Authorized Official

Name: TERRENCE MUNDY
Title or Position: OWNER
Credential:
Phone: 718-634-4800