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General NPI Number Information
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NPI Number | 1710251160
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Entity Type | Organization
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Legal Business Name | CHIROCORE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 03/04/2012
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Provider Practice Location Address
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Address Line | 1350 HICKSVILLE RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-1219
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Country | US
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Telephone | 516-343-6661
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Fax | 516-798-5652
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Provider Business Mailing Address
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Address Line | 1350 HICKSVILLE RD
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City | MASSAPEQUA
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State | NY
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Zip | 11758-1219
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Country | US
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Telephone | 516-343-6661
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Fax | 516-798-5652
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC-OWNER
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Name | DR. ROBERT JAMES BENCIVENGA
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Credential | D.C.
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Telephone | 516-343-6661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 012125
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License Number State | NY
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