Provider Demographics
NPI:1417121070
Name:HOLTSVILLE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:HOLTSVILLE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEAHY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-654-7900
Mailing Address - Street 1:1018 WAVERLY AVE
Mailing Address - Street 2:SUITE13
Mailing Address - City:HOLTSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11742-1128
Mailing Address - Country:US
Mailing Address - Phone:631-654-7900
Mailing Address - Fax:631-654-7972
Practice Address - Street 1:1018 WAVERLY AVE
Practice Address - Street 2:SUITE13
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742-1128
Practice Address - Country:US
Practice Address - Phone:631-654-7900
Practice Address - Fax:631-654-7972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX48051Medicare PIN