MEDICARE: NORTH MERRICK CHIROPRACTIC

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	X0067101	NY

General Provider Information

NPI Number	:	1952615874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH MERRICK CHIROPRACTIC

Provider Business Mailing Address
First Line	:	399 MERRICK AVE
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-2723
Country	:	US
Telephone Number	:	516-867-7096
Fax Number	:

Provider Business Practice Location Address
First Line	:	399 MERRICK AVE
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-2723
Country	:	US
Telephone Number	:	516-867-7096
Fax Number	:

Authorized Official
Title or Position	:	OFFICER MANAGER
Name	:	MRS. TONILYNN HOOVER
Credential	:
Telephone Number	:	516-867-7096

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/03/2010

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