Healthcare Provider Details

I. General information

NPI: 1326554569
Provider Name (Legal Business Name): ISLAND CHIROPRACTIC IMAGING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2017
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 N JERUSALEM RD
NORTH BELLMORE NY
11710-1108
US

IV. Provider business mailing address

1860 N JERUSALEM RD
NORTH BELLMORE NY
11710-1108
US

V. Phone/Fax

Practice location:
  • Phone: 516-554-8840
  • Fax:
Mailing address:
  • Phone: 516-554-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License NumberX009726
License Number StateNY

VIII. Authorized Official

Name: DR. BRETT DAVID SPILLER
Title or Position: OWNER
Credential: DC
Phone: 516-554-8840