Provider Demographics
NPI:1376778365
Name:SMITELLI CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SMITELLI CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SMITELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-755-2225
Mailing Address - Street 1:185 MERRITTS RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3254
Mailing Address - Country:US
Mailing Address - Phone:516-755-2225
Mailing Address - Fax:516-249-2370
Practice Address - Street 1:185 MERRITTS RD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3254
Practice Address - Country:US
Practice Address - Phone:516-755-2225
Practice Address - Fax:516-249-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-20
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006435111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty