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General NPI Number Information
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NPI Number | 1548327265
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Entity Type | Organization
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Legal Business Name | SACKS CHIROPRACTIC, PC
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 12/13/2007
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Provider Practice Location Address
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Address Line | 3771 NESCONSET HWY STE. 210
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City | CENTEREACH
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State | NY
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Zip | 11720-1154
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Country | US
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Telephone | 631-751-7701
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Fax | 631-751-7701
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Provider Business Mailing Address
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Address Line | 15 CORNELIA LN
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City | LAKE GROVE
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State | NY
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Zip | 11755-2507
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Country | US
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Telephone | 631-585-4125
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Fax | 631-751-7701
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD ALLEN SACKS
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Credential | DC
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Telephone | 631-751-7701
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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 | X004997
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License Number State | NY
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