Provider Demographics
NPI:1811207301
Name:IMMEDIATE CHIROPRACTIC CARE BY DR. FRANK GOMEZ P.C.
Entity Type:Organization
Organization Name:IMMEDIATE CHIROPRACTIC CARE BY DR. FRANK GOMEZ P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:MANUEL
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:631-991-3492
Mailing Address - Street 1:4844 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1011
Mailing Address - Country:US
Mailing Address - Phone:631-991-3492
Mailing Address - Fax:631-563-1074
Practice Address - Street 1:4844 SUNRISE HWY
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1011
Practice Address - Country:US
Practice Address - Phone:631-991-3492
Practice Address - Fax:631-563-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005177111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X28531Medicare PIN