Provider Demographics
NPI:1568892255
Name:TICE, CHRISTOPHER LORENZO (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:LORENZO
Last Name:TICE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LAKEVILLE RD
Mailing Address - Street 2:SUITE103
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1120
Mailing Address - Country:US
Mailing Address - Phone:516-208-9360
Mailing Address - Fax:516-208-9360
Practice Address - Street 1:444 LAKEVILLE RD
Practice Address - Street 2:SUITE103
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1120
Practice Address - Country:US
Practice Address - Phone:516-208-9360
Practice Address - Fax:516-208-9360
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005507-1111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology