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General NPI Number Information
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NPI Number | 1942562350
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE CHIROPRACTIC PC
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 2120 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1849
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Country | US
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Telephone | 516-794-0414
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Fax | 516-794-0435
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Provider Business Mailing Address
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Address Line | 2120 HEMPSTEAD TPKE
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City | EAST MEADOW
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State | NY
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Zip | 11554-1849
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Country | US
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Telephone | 516-794-0414
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Fax | 516-794-0435
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARIANN PERRETTA
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Credential | DC
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Telephone | 516-794-0414
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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 | X008047
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License Number State | NY
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