Provider Demographics
NPI:1639580137
Name:QUANTUM CHIROPRACTIC DIAGNOSTIC, PC
Entity Type:Organization
Organization Name:QUANTUM CHIROPRACTIC DIAGNOSTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-377-7213
Mailing Address - Street 1:1010 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-5100
Mailing Address - Country:US
Mailing Address - Phone:516-377-7213
Mailing Address - Fax:516-377-6235
Practice Address - Street 1:1010 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570-5100
Practice Address - Country:US
Practice Address - Phone:516-377-7213
Practice Address - Fax:516-377-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty