Provider Demographics
NPI:1508306333
Name:HEAD TO TOE CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:HEAD TO TOE CHIROPRACTIC, PLLC
Other - Org Name:OPTIMUM CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:TARA
Authorized Official - Last Name:MACKEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-689-0049
Mailing Address - Street 1:2500 NESCONSET HIGHWAY
Mailing Address - Street 2:BUILDING 9B
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790
Mailing Address - Country:US
Mailing Address - Phone:631-689-0049
Mailing Address - Fax:631-689-0071
Practice Address - Street 1:2500 NESCONSET HIGHWAY
Practice Address - Street 2:BUILDING 9B
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790
Practice Address - Country:US
Practice Address - Phone:631-689-0049
Practice Address - Fax:631-689-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007538-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC075384OtherWORKERS COMPENSATION
X97331OtherBC/BS
5899840OtherGHI
NYX97331Medicare PIN
NY9297331Medicare PIN
X97331OtherBC/BS