Provider Demographics
NPI:1497729925
Name:ARNOLD, GREG (DC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:M
Credentials:DC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:
Mailing Address - City:NESCONSET
Mailing Address - State:NY
Mailing Address - Zip Code:11767-0627
Mailing Address - Country:US
Mailing Address - Phone:631-352-7654
Mailing Address - Fax:925-886-4897
Practice Address - Street 1:1745 EXPRESS DR N
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5303
Practice Address - Country:US
Practice Address - Phone:631-352-7654
Practice Address - Fax:925-886-4897
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC29442111N00000X
NY012159111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA731721436OtherTIN