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General NPI Number Information
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NPI Number | 1124938758
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Entity Type | Organization
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Legal Business Name | ISLAND CHIROPRACTIC OFFICE PC
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Dates
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Enumeration Date | 09/08/2026
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Last Update Date | 09/08/2026
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Provider Practice Location Address
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Address Line | 7 WALNUT RD
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City | GLEN COVE
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State | NY
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Zip | 11542-2267
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Country | US
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Telephone | 516-609-3100
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Fax | 516-609-3300
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Provider Business Mailing Address
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Address Line | 7 WALNUT RD
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City | GLEN COVE
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State | NY
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Zip | 11542-2267
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Country | US
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Telephone | 516-609-3100
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Fax | 516-609-3300
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Authorized Official
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Title or Position | OWNER
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Name | MANUEL A MENDOZA JR.
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Credential | DC
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Telephone | 516-474-6943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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