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General NPI Number Information
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NPI Number | 1669969408
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Entity Type | Organization
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Legal Business Name | COMMACK CHIROPRACTIC, PC
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Dates
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Enumeration Date | 04/17/2018
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Last Update Date | 04/17/2018
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Provider Practice Location Address
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Address Line | 2171 JERICHO TPKE STE 131
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City | COMMACK
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State | NY
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Zip | 11725-2900
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Country | US
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Telephone | 631-462-6565
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Fax | 631-462-6018
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Provider Business Mailing Address
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Address Line | 2171 JERICHO TPKE STE 131
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City | COMMACK
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State | NY
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Zip | 11725-2900
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Country | US
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Telephone | 631-462-6565
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Fax | 631-462-6018
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SHARON ANN OSTERMEIR
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Credential | DC
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Telephone | 631-462-6565
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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 | X004613-1
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License Number State | NY
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