Healthcare Provider Details

I. General information

NPI: 1275618761
Provider Name (Legal Business Name): SAYVILLE CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 SUNRISE HWY
SAYVILLE NY
11782-1011
US

IV. Provider business mailing address

4844 SUNRISE HWY
SAYVILLE NY
11782-1011
US

V. Phone/Fax

Practice location:
  • Phone: 631-563-1444
  • Fax: 563-563-1074
Mailing address:
  • Phone: 631-563-1444
  • Fax: 563-563-1074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberX005177
License Number StateNY

VIII. Authorized Official

Name: DR. FRANK MANUEL GOMEZ JR.
Title or Position: PRESIDENT
Credential: D.C.
Phone: 631-563-1444