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General NPI Number Information
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NPI Number | 1790078160
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC CARE OF LONG ISLAND P.C.
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 05/18/2011
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Provider Practice Location Address
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Address Line | 214 WALL ST SUITE 300
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City | HUNTINGTON
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State | NY
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Zip | 11743-7804
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Country | US
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Telephone | 631-673-5433
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Fax | 631-673-5435
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Provider Business Mailing Address
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Address Line | 214 WALL ST SUITE 300
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City | HUNTINGTON
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State | NY
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Zip | 11743-7804
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Country | US
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Telephone | 631-673-5433
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Fax | 631-673-5435
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW J LALOR
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Credential | D.C.
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Telephone | 631-673-5433
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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 | X011878
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License Number State | NY
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