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General NPI Number Information
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NPI Number | 1447593710
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Entity Type | Organization
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Legal Business Name | ADVANTAGE MASSAGE THERAPY, CHIROPRACTIC & ACUPUNCTURE, PLLC
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Dates
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Enumeration Date | 04/04/2013
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 535 BROADHOLLOW RD
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City | MELVILLE
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State | NY
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Zip | 11747-3713
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Country | US
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Telephone | 631-404-6377
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Fax |
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Provider Business Mailing Address
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Address Line | 193 N WELLWOOD AVE
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City | LINDENHURST
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State | NY
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Zip | 11757-4080
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Country | US
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Telephone | 631-404-6377
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | GARY CULLIN
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Credential |
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Telephone | 631-404-6377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004878
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License Number State | NY
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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 | 008902
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License Number State | NY
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