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General NPI Number Information
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NPI Number | 1720113236
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Entity Type | Organization
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Legal Business Name | ADVANCED CHIROPRACTIC OF SHIRLEY, PC
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Dates
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Enumeration Date | 02/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 691 MONTAUK HWY
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City | SHIRLEY
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State | NY
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Zip | 11967-2123
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Country | US
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Telephone | 631-281-1200
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Fax | 631-506-8429
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Provider Business Mailing Address
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Address Line | 691 MONTAUK HWY
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City | SHIRLEY
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State | NY
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Zip | 11967-2123
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Country | US
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Telephone | 631-281-1200
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Fax | 631-506-8429
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. CHRISTOPHER WAYRICH
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Credential | DC
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Telephone | 631-281-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | X009749-1
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License Number State | NY
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