Healthcare Provider Details

I. General information

NPI: 1992879902
Provider Name (Legal Business Name): FAMILY WELLNESS CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 MONTAUK HWY
COPIAGUE NY
11726-4924
US

IV. Provider business mailing address

57 MONTAUK HWY
COPIAGUE NY
11726-4924
US

V. Phone/Fax

Practice location:
  • Phone: 631-956-3080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLANNE VENTURA
Title or Position: PRESIDENT
Credential: DC
Phone: 631-956-3080