Provider Demographics
NPI:1659676161
Name:PERNICE CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:PERNICE CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERNICE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:631-736-1000
Mailing Address - Street 1:301 MOONEY POND RD
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-3414
Mailing Address - Country:US
Mailing Address - Phone:631-736-1000
Mailing Address - Fax:631-736-1023
Practice Address - Street 1:301 MOONEY POND RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-3414
Practice Address - Country:US
Practice Address - Phone:631-736-1000
Practice Address - Fax:631-736-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-13
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005707-07111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty