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General NPI Number Information
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NPI Number | 1710109665
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC ASSOCIATES OF LONG ISLAND PC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 195 SMITHTOWN BLVD STE 105
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City | NESCONSET
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State | NY
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Zip | 11767
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Country | US
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Telephone | 631-724-1991
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Fax | 631-724-1995
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Provider Business Mailing Address
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Address Line | 195 SMITHTOWN BLVD STE 105
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City | NESCONSET
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State | NY
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Zip | 11767
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Country | US
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Telephone | 631-724-1991
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Fax | 631-724-1995
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Authorized Official
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Title or Position | PRESIDENT
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Name | GERARD J SMITH
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Credential | DC
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Telephone | 631-724-1991
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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 | X006740
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License Number State | NY
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