Provider Demographics
NPI:1821676198
Name:MRNN CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:MRNN CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NESTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:NICOLAIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-705-5600
Mailing Address - Street 1:30 S OCEAN AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3550
Mailing Address - Country:US
Mailing Address - Phone:516-705-5600
Mailing Address - Fax:516-705-5602
Practice Address - Street 1:30 S OCEAN AVE RM 102
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3550
Practice Address - Country:US
Practice Address - Phone:516-705-5600
Practice Address - Fax:516-705-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty