Provider Demographics
NPI:1720113236
Name:ADVANCED CHIROPRACTIC OF SHIRLEY, PC
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF SHIRLEY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-281-1200
Mailing Address - Street 1:691 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2123
Mailing Address - Country:US
Mailing Address - Phone:631-281-1200
Mailing Address - Fax:631-506-8429
Practice Address - Street 1:691 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2123
Practice Address - Country:US
Practice Address - Phone:631-281-1200
Practice Address - Fax:631-506-8429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009749-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU88120Medicare UPIN
NYX5F411Medicare ID - Type UnspecifiedMEDICARE NUMBER