Provider Demographics
NPI:1295866358
Name:LONG ISLAND CHIROPRACTIC, HEALTH & WELLNESS, P.C.
Entity Type:Organization
Organization Name:LONG ISLAND CHIROPRACTIC, HEALTH & WELLNESS, P.C.
Other - Org Name:SMITHTOWN WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNENGRABER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-361-9355
Mailing Address - Street 1:285 MIDDLE COUNTRY RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:285 MIDDLE COUNTRY RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2978
Practice Address - Country:US
Practice Address - Phone:631-361-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty