Provider Demographics
NPI:1336210970
Name:CHIRO CARE CHIROPRACTIC OFFICE P.C.
Entity Type:Organization
Organization Name:CHIRO CARE CHIROPRACTIC OFFICE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KULIK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-454-0400
Mailing Address - Street 1:1121 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:N MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1341
Mailing Address - Country:US
Mailing Address - Phone:516-454-0400
Mailing Address - Fax:516-454-0406
Practice Address - Street 1:1121 N BROADWAY
Practice Address - Street 2:
Practice Address - City:N MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1341
Practice Address - Country:US
Practice Address - Phone:516-454-0400
Practice Address - Fax:516-454-0406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0029751111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWXYQQ1Medicare PIN
T52326Medicare UPIN