Provider Demographics
NPI:1326589094
Name:LONG ISLAND CHIROPRACTIC, P.C.
Entity Type:Organization
Organization Name:LONG ISLAND CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:D'BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-609-0890
Mailing Address - Street 1:10 CEDAR SWAMP RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-3700
Mailing Address - Country:US
Mailing Address - Phone:516-609-0890
Mailing Address - Fax:
Practice Address - Street 1:10 CEDAR SWAMP RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-3700
Practice Address - Country:US
Practice Address - Phone:516-609-0890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty