Provider Demographics
NPI:1235817313
Name:GREAT SOUTH BAY CHIROPRACTIC
Entity Type:Organization
Organization Name:GREAT SOUTH BAY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARRAGO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-289-6767
Mailing Address - Street 1:105 MEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-1223
Mailing Address - Country:US
Mailing Address - Phone:631-289-6767
Mailing Address - Fax:631-289-6790
Practice Address - Street 1:105 MEDFORD AVE
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-1223
Practice Address - Country:US
Practice Address - Phone:631-289-6767
Practice Address - Fax:631-289-6790
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANDREW S FARRAGO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty