Provider Demographics
NPI:1851798490
Name:SUESSERMAN CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SUESSERMAN CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SUESSERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-967-0397
Mailing Address - Street 1:33 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3640
Mailing Address - Country:US
Mailing Address - Phone:631-425-9400
Mailing Address - Fax:631-425-0419
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-425-9400
Practice Address - Fax:631-425-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO 11327111N00000X
NYX011495111N00000X
NYX009397111N00000X
NYXOO9397111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty