Healthcare Provider Details

I. General information

NPI: 1881997351
Provider Name (Legal Business Name): DENNIS SALL CHIROPRACTIC, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 ROUTE 112 STE. 6
CORAM NY
11727-2300
US

IV. Provider business mailing address

1970 ROUTE 112 STE. 6
CORAM NY
11727-2300
US

V. Phone/Fax

Practice location:
  • Phone: 631-476-4600
  • Fax: 631-476-8236
Mailing address:
  • Phone: 631-476-4600
  • Fax: 631-476-8236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DENNIS PATRICK SALL
Title or Position: PRESIDENT
Credential: D.C., DPT
Phone: 631-476-4600