Provider Demographics
NPI:1427384056
Name:JJ & R CHIROPRACTIC PC
Entity Type:Organization
Organization Name:JJ & R CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:GAMBINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-554-4929
Mailing Address - Street 1:389 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-6126
Mailing Address - Country:US
Mailing Address - Phone:516-554-4929
Mailing Address - Fax:718-205-2245
Practice Address - Street 1:389 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-6126
Practice Address - Country:US
Practice Address - Phone:516-554-4929
Practice Address - Fax:718-205-2245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010987302F00000X, 302R00000X, 305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization