Provider Demographics
NPI:1679794945
Name:MUCHNICK, MORDECAI JUDAH (DC)
Entity Type:Individual
Prefix:
First Name:MORDECAI
Middle Name:JUDAH
Last Name:MUCHNICK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:MORDECAI
Other - Middle Name:JUDAH
Other - Last Name:MUCHNICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC PC
Mailing Address - Street 1:367 HEMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2044
Mailing Address - Country:US
Mailing Address - Phone:516-483-0327
Mailing Address - Fax:516-483-0330
Practice Address - Street 1:367 HEMPSTEAD AVE
Practice Address - Street 2:
Practice Address - City:WEST HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11552-2044
Practice Address - Country:US
Practice Address - Phone:516-483-0327
Practice Address - Fax:516-483-0330
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0022331111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
XCWWA1Medicare ID - Type Unspecified