Provider Demographics
NPI:1043426679
Name:HUNTINGTON CHIROPRACTIC HEALTH & WELLNESS,P.C.
Entity Type:Organization
Organization Name:HUNTINGTON CHIROPRACTIC HEALTH & WELLNESS,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-425-0500
Mailing Address - Street 1:199 OAKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4213
Mailing Address - Country:US
Mailing Address - Phone:631-425-0500
Mailing Address - Fax:631-425-3399
Practice Address - Street 1:199 OAKWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-4213
Practice Address - Country:US
Practice Address - Phone:631-425-0500
Practice Address - Fax:631-425-3399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009190111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX7B621Medicare ID - Type Unspecified