MEDICARE: FANTASTIC CHIROPRACTIC PC

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	X011045-1	NY

General Provider Information

NPI Number	:	1942438346
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FANTASTIC CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	2631 BELMILL RD
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-4512
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2631 BELMILL RD
Second Line	:
City	:	BELLMORE
State	:	NY
Zip	:	11710-4512
Country	:	US
Telephone Number	:	516-742-8884
Fax Number	:	516-977-4656

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL LAMONTAGNE
Credential	:	DC
Telephone Number	:	516-742-8884

Provider Enumeration Date	:	06/24/2009
Last Update Date	:	06/24/2009

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Directions to “FANTASTIC CHIROPRACTIC PC ” Practice Location

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