=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235923525
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HILLS CHIROPRACTIC & PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2025
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 FULTON AVE STE 11
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-3648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-486-4666
-----------------------------------------------------
Fax | 516-479-0214
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 FULTON AVE STE 11
-----------------------------------------------------
City | HEMPSTEAD
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11550-3648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-486-4666
-----------------------------------------------------
Fax | 516-479-0214
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL SCOTT ROTH
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 516-489-4666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------