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General NPI Number Information
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NPI Number | 1417471202
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Entity Type | Organization
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Legal Business Name | BRANDON M HENKOWICZ DC, P.C.
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Dates
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Enumeration Date | 08/02/2017
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Last Update Date | 11/10/2017
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Provider Practice Location Address
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Address Line | 2500 NESCONSET HWY
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City | STONY BROOK
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State | NY
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Zip | 11790-2555
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Country | US
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Telephone | 631-689-0049
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Fax | 631-689-0071
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Provider Business Mailing Address
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Address Line | 2500 NESCONSET HWY BLDG 9B
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City | STONY BROOK
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State | NY
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Zip | 11790-2553
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Country | US
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Telephone | 631-689-0049
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Fax | 631-689-0071
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON HENKOWICZ
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Credential | DC
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Telephone | 631-689-0049
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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 | X012178
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License Number State | NY
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