Provider Demographics
NPI:1669969408
Name:COMMACK CHIROPRACTIC, PC
Entity type:Organization
Organization Name:COMMACK CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:OSTERMEIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-462-6565
Mailing Address - Street 1:2171 JERICHO TPKE STE 131
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-2900
Mailing Address - Country:US
Mailing Address - Phone:631-462-6565
Mailing Address - Fax:631-462-6018
Practice Address - Street 1:2171 JERICHO TPKE STE 131
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-2900
Practice Address - Country:US
Practice Address - Phone:631-462-6565
Practice Address - Fax:631-462-6018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004613-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty