=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477827061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OAKDALE CHIROPRACTIC AND ACUPUNCTURE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2012
-----------------------------------------------------
Last Update Date | 06/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1231 MONTAUK HWY
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11769-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-218-2888
-----------------------------------------------------
Fax | 631-218-0261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1231 MONTAUK HWY
-----------------------------------------------------
City | OAKDALE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11769-1434
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-218-2888
-----------------------------------------------------
Fax | 631-218-0261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DR.
-----------------------------------------------------
Name | DR. DOREEN A SUNDIN
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 631-218-2888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X04099-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------