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General NPI Number Information
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NPI Number | 1245184266
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Entity Type | Organization
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Legal Business Name | LI CHIROPRACTIC & NURSE PRACTITIONER IN ADULT HEALTH, PLLC
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Dates
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Enumeration Date | 02/25/2026
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Last Update Date | 02/25/2026
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Provider Practice Location Address
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Address Line | 20 GILBERT AVE STE 201
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City | SMITHTOWN
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State | NY
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Zip | 11787-5312
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Country | US
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Telephone | 631-360-0170
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Fax | 631-724-0984
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Provider Business Mailing Address
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Address Line | 20 GILBERT AVE STE 201
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City | SMITHTOWN
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State | NY
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Zip | 11787-5312
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Country | US
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Telephone | 631-360-0170
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Fax | 631-724-0984
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Authorized Official
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Title or Position | OWNER
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Name | DONALD WALLACE
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Credential |
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Telephone | 631-360-0170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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