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General NPI Number Information
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NPI Number | 1720375488
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Entity Type | Organization
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Legal Business Name | 3 VILLAGE CHIROPRACTIC PLLC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 128 OLD TOWN RD SUITE C
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City | SETAUKET
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State | NY
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Zip | 11733-2064
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Country | US
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Telephone | 631-675-2910
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Fax | 631-675-2912
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Provider Business Mailing Address
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Address Line | 128 OLD TOWN RD SUITE C
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City | SETAUKET
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State | NY
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Zip | 11733-2064
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Country | US
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Telephone | 631-675-2910
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Fax | 631-675-2912
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Authorized Official
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Title or Position | CEO
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Name | DR. BRIAN SCOTT ROTH
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Credential | D.C.
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Telephone | 631-675-2910
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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 |
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License Number State |
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