Healthcare Provider Details

I. General information

NPI: 1851751838
Provider Name (Legal Business Name): MANHASSET CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2016
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 NORTHERN BLVD STE 106B
GREAT NECK NY
11021-5118
US

IV. Provider business mailing address

560 NORTHERN BLVD STE 106B
GREAT NECK NY
11021-5118
US

V. Phone/Fax

Practice location:
  • Phone: 516-466-6164
  • Fax: 516-304-5712
Mailing address:
  • Phone: 516-466-6164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. GARRETT ILG REICHELT
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 631-682-1544