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General NPI Number Information
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NPI Number | 1740357961
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Entity Type | Organization
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Legal Business Name | SUNRISE CHIROPRACTIC PC
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Dates
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Enumeration Date | 11/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3900 SUNRISE HIGHWAY SUITE 1
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City | SEAFORD
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State | NY
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Zip | 11783
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Country | US
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Telephone | 516-826-1800
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Fax | 516-826-0043
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Provider Business Mailing Address
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Address Line | 3900 SUNRISE HIGHWAY SUITE 1
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City | SEAFORD
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State | NY
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Zip | 11783
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Country | US
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Telephone | 516-826-1800
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Fax | 516-826-0043
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Authorized Official
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Title or Position | PRES
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Name | DR. BRIAN YODICE
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Credential | DC
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Telephone | 516-991-0438
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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 | X009553
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License Number State | NY
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