Provider Demographics
NPI:1851751838
Name:MANHASSET CHIROPRACTIC PC
Entity Type:Organization
Organization Name:MANHASSET CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:ILG
Authorized Official - Last Name:REICHELT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-682-1544
Mailing Address - Street 1:560 NORTHERN BLVD
Mailing Address - Street 2:STE 106B
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-5118
Mailing Address - Country:US
Mailing Address - Phone:516-466-6164
Mailing Address - Fax:
Practice Address - Street 1:560 NORTHERN BLVD
Practice Address - Street 2:STE 106B
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-5118
Practice Address - Country:US
Practice Address - Phone:516-466-6164
Practice Address - Fax:516-304-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
No111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
No111NX0100XChiropractic ProvidersChiropractorOccupational HealthGroup - Single Specialty
No111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty