=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811207301
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IMMEDIATE CHIROPRACTIC CARE BY DR. FRANK GOMEZ P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2010
-----------------------------------------------------
Last Update Date | 01/28/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4844 SUNRISE HWY
-----------------------------------------------------
City | SAYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11782-1011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-991-3492
-----------------------------------------------------
Fax | 631-563-1074
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4844 SUNRISE HWY
-----------------------------------------------------
City | SAYVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11782-1011
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-991-3492
-----------------------------------------------------
Fax | 631-563-1074
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DOCTOR
-----------------------------------------------------
Name | DR. FRANK MANUEL GOMEZ JR.
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 631-991-3492
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | X005177
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------