Provider Demographics
NPI:1851388425
Name:TUCHOLSKI, LEON R JR (DC)
Entity Type:Individual
Prefix:DR
First Name:LEON
Middle Name:R
Last Name:TUCHOLSKI
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5021
Mailing Address - Country:US
Mailing Address - Phone:516-799-3200
Mailing Address - Fax:516-799-2066
Practice Address - Street 1:583 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5021
Practice Address - Country:US
Practice Address - Phone:516-799-3200
Practice Address - Fax:516-799-2066
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0107581111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6V681Medicare ID - Type Unspecified