Provider Demographics
NPI:1992834543
Name:COMPLETE CHIROPRACTIC REHABILITATION PC
Entity Type:Organization
Organization Name:COMPLETE CHIROPRACTIC REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TANZA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:631-689-8662
Mailing Address - Street 1:140 N BELLE MEAD AVE STE D
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6400
Mailing Address - Country:US
Mailing Address - Phone:631-689-8662
Mailing Address - Fax:
Practice Address - Street 1:140 BELLE MEAD RD
Practice Address - Street 2:SUITE D
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6400
Practice Address - Country:US
Practice Address - Phone:631-689-8662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100000056Medicare PIN