Provider Demographics
NPI:1508800889
Name:CONNETQUOT CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:CONNETQUOT CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET GROSCHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GROSCHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-926-1115
Mailing Address - Street 1:2805 VETERANS MEMORIAL HWY
Mailing Address - Street 2:SUITE 8
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7647
Mailing Address - Country:US
Mailing Address - Phone:631-738-9539
Mailing Address - Fax:631-738-8500
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7647
Practice Address - Country:US
Practice Address - Phone:631-738-9539
Practice Address - Fax:631-738-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX4362111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXKW892Medicare ID - Type Unspecified
NYXKW891Medicare ID - Type Unspecified