Provider Demographics
NPI:1407978489
Name:SUFFOLK FAMILY CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:SUFFOLK FAMILY CHIROPRACTIC, P.C.
Other - Org Name:BACK TO LIFE CHIROPRACTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:718-424-4455
Mailing Address - Street 1:4322 50TH ST
Mailing Address - Street 2:SUITE 1-B
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4442
Mailing Address - Country:US
Mailing Address - Phone:718-424-4455
Mailing Address - Fax:718-478-8672
Practice Address - Street 1:4322 50TH ST
Practice Address - Street 2:SUITE 1-B
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4442
Practice Address - Country:US
Practice Address - Phone:718-424-4455
Practice Address - Fax:718-478-8672
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC-007735-6B111NI0013X, 111NN0400X, 111NS0005X, 111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Not Answered111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Not Answered111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Not Answered111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty