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General NPI Number Information
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NPI Number | 1053818369
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Entity Type | Organization
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Legal Business Name | ENVISION WELLNESS CHIROPRACTIC PC
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 10/20/2022
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Provider Practice Location Address
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Address Line | 1461 LAKELAND AVE SUITE 9
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City | BOHEMIA
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State | NY
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Zip | 11716
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Country | US
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Telephone | 631-467-8224
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Fax | 631-585-7575
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Provider Business Mailing Address
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Address Line | 1461 LAKELAND AVE SUITE 9
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City | BOHEMIA
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State | NY
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Zip | 11716
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Country | US
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Telephone | 631-467-8224
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Fax | 631-585-7575
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Authorized Official
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Title or Position | PRES./OWNER
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Name | DR. FREDERICK TINARI
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Credential | DC
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Telephone | 631-467-8224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | X003397-1
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License Number State | NY
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