Healthcare Provider Details

I. General information

NPI: 1669306429
Provider Name (Legal Business Name): BEACH CHIROPRACTIC WELLNESS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 SUNRISE HWY
WEST BABYLON NY
11704-6110
US

IV. Provider business mailing address

972 SUNRISE HWY
WEST BABYLON NY
11704-6110
US

V. Phone/Fax

Practice location:
  • Phone: 631-422-6675
  • Fax: 631-422-6718
Mailing address:
  • Phone: 631-422-6675
  • Fax: 631-422-6718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: NADINE S BEACH
Title or Position: OWNER
Credential: DC
Phone: 631-422-6675