Provider Demographics
NPI:1114363041
Name:IN MOTION CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:IN MOTION CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-560-1105
Mailing Address - Street 1:59 DOROTHY ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-1722
Mailing Address - Country:US
Mailing Address - Phone:888-959-0712
Mailing Address - Fax:888-959-0712
Practice Address - Street 1:59 DOROTHY ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-1722
Practice Address - Country:US
Practice Address - Phone:888-959-0712
Practice Address - Fax:888-959-0712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009495111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX4N191Medicare PIN