Individual
GUSTAVO MEJIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
8 MAPLE AVE, BAY SHORE, NY 11706-8722
(631) 968-0586
(631) 968-6720
Mailing address
8 MAPLE AVE, BAY SHORE, NY 11706-8722
(631) 968-0586
(631) 968-6720
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X003936
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X003936
LICENSE
NY
Enumeration date
08/05/2007
Last updated
08/05/2007
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