Provider Demographics
NPI:1225155948
Name:OCEAN AVENUE CHIROPRACTIC P.C
Entity Type:Organization
Organization Name:OCEAN AVENUE CHIROPRACTIC P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-737-4676
Mailing Address - Street 1:700 UNION PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7427
Mailing Address - Country:US
Mailing Address - Phone:631-737-4676
Mailing Address - Fax:631-737-1261
Practice Address - Street 1:700 UNION PKWY STE 3
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7427
Practice Address - Country:US
Practice Address - Phone:631-737-4676
Practice Address - Fax:631-737-1261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-009025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty