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General NPI Number Information
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NPI Number | 1982210555
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Entity Type | Organization
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Legal Business Name | RIVERHEAD CHIROPRACTIC WELLNESS, PC
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Dates
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Enumeration Date | 09/19/2020
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Last Update Date | 09/19/2020
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Provider Practice Location Address
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Address Line | 160 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2198
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Country | US
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Telephone | 631-727-7200
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Fax | 631-727-7252
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Provider Business Mailing Address
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Address Line | 160 OLD COUNTRY RD
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City | RIVERHEAD
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State | NY
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Zip | 11901-2198
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Country | US
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Telephone | 631-727-7200
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Fax | 631-727-7252
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | BRIAN BOGDANSKI
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Credential | DC
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Telephone | 631-727-7200
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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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