Provider Demographics
NPI:1093966327
Name:BELLPORT CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:BELLPORT CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STUTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-286-9410
Mailing Address - Street 1:112 S COUNTRY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2534
Mailing Address - Country:US
Mailing Address - Phone:631-286-9410
Mailing Address - Fax:631-286-6491
Practice Address - Street 1:112 S COUNTRY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2534
Practice Address - Country:US
Practice Address - Phone:631-286-9410
Practice Address - Fax:631-286-6491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008989111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6260750001Medicare NSC
NYA100000507Medicare PIN