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General NPI Number Information
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NPI Number | 1164971297
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Entity Type | Organization
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Legal Business Name | STRUCTURE PRO CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 2805 VETERANS MEMORIAL HWY #8
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City | RONKONKOMA
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State | NY
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Zip | 11779-7647
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Country | US
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Telephone | 631-440-1589
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Fax |
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Provider Business Mailing Address
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Address Line | 2805 VETERANS MEMORIAL HWY #8
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City | RONKONKOMA
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State | NY
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Zip | 11779-7647
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Country | US
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Telephone | 631-440-1589
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. HOWARD GREEN
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Credential | D.C.
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Telephone | 631-440-1589
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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 | X007953
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License Number State | NY
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