Provider Demographics
NPI:1164475695
Name:TRUE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:TRUE CHIROPRACTIC PLLC
Other - Org Name:TRUE SPORT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:S
Authorized Official - Last Name:TACZANOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-584-8783
Mailing Address - Street 1:62 LAKE AVE S
Mailing Address - Street 2:SUITE C
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-1094
Mailing Address - Country:US
Mailing Address - Phone:631-584-8783
Mailing Address - Fax:631-584-8784
Practice Address - Street 1:62 LAKE AVE S
Practice Address - Street 2:SUITE C
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1094
Practice Address - Country:US
Practice Address - Phone:631-584-8783
Practice Address - Fax:631-584-8784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty