Provider Demographics
NPI:1164971297
Name:STRUCTURE PRO CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:STRUCTURE PRO CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-440-1589
Mailing Address - Street 1:2805 VETERANS MEMORIAL HWY
Mailing Address - Street 2:#8
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-7647
Mailing Address - Country:US
Mailing Address - Phone:631-440-1589
Mailing Address - Fax:
Practice Address - Street 1:2805 VETERANS MEMORIAL HWY
Practice Address - Street 2:#8
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-7647
Practice Address - Country:US
Practice Address - Phone:631-440-1589
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty