=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023135332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE ANNE CAPURSO L.A.C., DC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/23/2007
-----------------------------------------------------
Last Update Date | 03/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 E MAIN ST STE 115
-----------------------------------------------------
City | EAST PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-419-6300
-----------------------------------------------------
Fax | 888-880-9756
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 E MAIN ST STE 115
-----------------------------------------------------
City | EAST PATCHOGUE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11772-3121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-419-6300
-----------------------------------------------------
Fax | 888-880-9756
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 008494
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 006493
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------