Provider Demographics
NPI:1669609350
Name:SEA CHANGE CHIROPRACTIC AND WELLNESS
Entity type:Organization
Organization Name:SEA CHANGE CHIROPRACTIC AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMITAI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOROB
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-256-9355
Mailing Address - Street 1:821 CLIFF ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2017
Mailing Address - Country:US
Mailing Address - Phone:607-256-9355
Mailing Address - Fax:607-275-9355
Practice Address - Street 1:821 CLIFF ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2017
Practice Address - Country:US
Practice Address - Phone:607-256-9355
Practice Address - Fax:607-275-9355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-19
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011697111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty