Provider Demographics
NPI:1033481098
Name:TYMER CARE CHIROPRACTIC, PC
Entity type:Organization
Organization Name:TYMER CARE CHIROPRACTIC, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CWIBEKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-584-1619
Mailing Address - Street 1:761 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2636
Mailing Address - Country:US
Mailing Address - Phone:516-584-1619
Mailing Address - Fax:516-569-0159
Practice Address - Street 1:761 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2636
Practice Address - Country:US
Practice Address - Phone:516-584-1619
Practice Address - Fax:516-569-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX16981Medicare PIN