Healthcare Provider Details

I. General information

NPI: 1821676198
Provider Name (Legal Business Name): MRNN CHIROPRACTIC P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 04/12/2021
Certification Date: 04/12/2021
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
FREEPORT NY
11520-3550
US

V. Phone/Fax

Practice location:
  • Phone: 516-705-5600
  • Fax: 516-705-5602
Mailing address:
  • Phone: 516-705-5600
  • Fax: 516-705-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. NESTOR NICOLAIDES
Title or Position: OWNER/OPERATOR
Credential: DC
Phone: 516-705-5600