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General NPI Number Information
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NPI Number | 1942576210
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Entity Type | Organization
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Legal Business Name | WEM DIAGNOSTIC CHIROPRACTIC SERVICES PC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 31 GUY LOMBARDO AVE STE 2
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City | FREEPORT
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State | NY
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Zip | 11520-3632
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Country | US
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Telephone | 516-213-4610
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Fax | 516-213-4819
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Provider Business Mailing Address
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Address Line | 31 GUY LOMBARDO AVE STE 2
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City | FREEPORT
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State | NY
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Zip | 11520-3632
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Country | US
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Telephone | 516-213-4610
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Fax | 516-213-4819
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. WALTER ENRIQUE MENDOZA
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Credential | DC
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Telephone | 516-213-4610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 010611
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License Number State | NY
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