Healthcare Provider Details

I. General information

NPI: 1639625775
Provider Name (Legal Business Name): ELYSE VICTORIA TURSI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2016
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 COMMACK RD
COMMACK NY
11725-3405
US

IV. Provider business mailing address

66 COMMACK RD
COMMACK NY
11725-3405
US

V. Phone/Fax

Practice location:
  • Phone: 631-462-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberX012856
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: