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NPI Code Detail

MEDICARE: FANTASTIC CHIROPRACTIC PC

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
1111N00000XChiropractorX011045-1NY

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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