Healthcare Provider Details

I. General information

NPI: 1942393368
Provider Name (Legal Business Name): JOHN JOSEPH SPANO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1247 SUFFOLK AVE SUITE 4
BRENTWOOD NY
11717-4518
US

IV. Provider business mailing address

1247 SUFFOLK AVE SUITE 4
BRENTWOOD NY
11717-4518
US

V. Phone/Fax

Practice location:
  • Phone: 631-434-7544
  • Fax:
Mailing address:
  • Phone: 631-434-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberX005506
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: