Provider Demographics
NPI:1669470647
Name:CHIERCHIE, STEVEN JN
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JN
Last Name:CHIERCHIE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-0400
Mailing Address - Country:US
Mailing Address - Phone:631-765-5151
Mailing Address - Fax:631-765-1162
Practice Address - Street 1:44210 MIDDLE ROAD, RTE. 48
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971
Practice Address - Country:US
Practice Address - Phone:631-765-5151
Practice Address - Fax:631-765-1162
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003972-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009224Medicare ID - Type Unspecified
X22471Medicare UPIN