MEDICARE: DR. SEAN P TRUJILLO DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X009294-1	NY

General Provider Information

NPI Number	:	1033274592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SEAN P TRUJILLO DC

Provider Business Mailing Address
First Line	:	PO BOX 351
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-0351
Country	:	US
Telephone Number	:	631-689-8662
Fax Number	:	631-689-5916

Provider Business Practice Location Address
First Line	:	140 BELLE MEAD RD
Second Line	:	SUITE D
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-6400
Country	:	US
Telephone Number	:	631-689-8662
Fax Number	:	631-689-5916

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	09/17/2009

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