=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447308150
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NADINE O'NEILL CHIROPRACTOR PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2007
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 WOODBINE AVE
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11768-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-262-6900
-----------------------------------------------------
Fax | 631-262-6900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 WOODBINE AVE
-----------------------------------------------------
City | NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11768-2897
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-262-6900
-----------------------------------------------------
Fax | 631-262-6900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NADINE O'NEILL
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 631-262-6900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------