Provider Demographics
NPI:1407925365
Name:SEA CLIFF CHIROPRACTIC OFFICE PC
Entity Type:Organization
Organization Name:SEA CLIFF CHIROPRACTIC OFFICE PC
Other - Org Name:SEA CLIFF CHIROPRACTIC OFFICE PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:CH
Authorized Official - Phone:516-759-2424
Mailing Address - Street 1:70 GLEN ST
Mailing Address - Street 2:SUITE 380
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2855
Mailing Address - Country:US
Mailing Address - Phone:516-759-2424
Mailing Address - Fax:516-759-6627
Practice Address - Street 1:70 GLEN ST
Practice Address - Street 2:SUITE 380
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2858
Practice Address - Country:US
Practice Address - Phone:516-759-2424
Practice Address - Fax:516-759-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT52221OtherUPIN
NYT52221OtherUPIN