Provider Demographics
NPI:1942576210
Name:WEM DIAGNOSTIC CHIROPRACTIC SERVICES PC
Entity Type:Organization
Organization Name:WEM DIAGNOSTIC CHIROPRACTIC SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-213-4610
Mailing Address - Street 1:31 GUY LOMBARDO AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11520-3632
Mailing Address - Country:US
Mailing Address - Phone:516-213-4610
Mailing Address - Fax:516-213-4819
Practice Address - Street 1:31 GUY LOMBARDO AVE STE 2
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:NY
Practice Address - Zip Code:11520-3632
Practice Address - Country:US
Practice Address - Phone:516-213-4610
Practice Address - Fax:516-213-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010611111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty