Provider Demographics
NPI:1205039914
Name:RESTORATION CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:RESTORATION CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:EBBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-526-2793
Mailing Address - Street 1:45 SYLVAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-1929
Mailing Address - Country:US
Mailing Address - Phone:631-331-3621
Mailing Address - Fax:631-331-3621
Practice Address - Street 1:45 SYLVAN AVE
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764-1929
Practice Address - Country:US
Practice Address - Phone:631-331-3621
Practice Address - Fax:631-331-3621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-010189111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty