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General NPI Number Information
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NPI Number | 1164631875
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Entity Type | Organization
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Legal Business Name | HOLBROOK CHIROPRACTIC PC
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 03/21/2008
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Provider Practice Location Address
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Address Line | 233 UNION AVE SUITE 102
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City | HOLBROOK
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State | NY
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Zip | 11741-1820
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Country | US
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Telephone | 631-981-2222
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Fax | 631-981-2279
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Provider Business Mailing Address
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Address Line | PO BOX 129 SUITE 102
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City | HOLBROOK
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State | NY
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Zip | 11741-0129
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Country | US
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Telephone | 631-981-2222
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Fax | 631-981-2279
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DOUGLASS MARK GLASSMAN
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Credential | DC
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Telephone | 631-981-2222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 006064
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License Number State | NY
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