Healthcare Provider Details

I. General information

NPI: 1386713246
Provider Name (Legal Business Name): RICHARD CARROLL SEARS JR. DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 GREGORY WAY
CALVERTON NY
11933-1137
US

IV. Provider business mailing address

9 GREGORY WAY
CALVERTON NY
11933-1137
US

V. Phone/Fax

Practice location:
  • Phone: 631-369-9218
  • Fax: 631-369-0988
Mailing address:
  • Phone: 631-369-9218
  • Fax: 631-369-0988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX005408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: