Healthcare Provider Details

I. General information

NPI: 1003564451
Provider Name (Legal Business Name): MRNN CHIROPRACTIC & PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S OCEAN AVE RM 102
FREEPORT NY
11520-3550
US

IV. Provider business mailing address

30 S OCEAN AVE RM 102
FREEPORT NY
11520-3550
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-5600
  • Fax:
Mailing address:
  • Phone: 516-705-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. NESTOR NICOLAIDES
Title or Position: MANAGING PARTNER
Credential: DC
Phone: 516-705-5600