Healthcare Provider Details

I. General information

NPI: 1285660027
Provider Name (Legal Business Name): ATLANTIQUE CHIROPRACTIC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WAVERLY AVE STE 3
PATCHOGUE NY
11772-1555
US

IV. Provider business mailing address

450 WAVERLY AVE STE 3
PATCHOGUE NY
11772-1555
US

V. Phone/Fax

Practice location:
  • Phone: 631-758-6444
  • Fax: 631-758-6379
Mailing address:
  • Phone: 631-758-6444
  • Fax: 631-758-6379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0065441
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019595
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID LEE SHAPIRO
Title or Position: PRESIDENT
Credential: DC
Phone: 631-758-6444