Provider Demographics
NPI:1508043142
Name:ISLAND REGIONAL CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:ISLAND REGIONAL CHIROPRACTIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TUBENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-427-6920
Mailing Address - Street 1:1890 NEW YORK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-2904
Mailing Address - Country:US
Mailing Address - Phone:631-427-6920
Mailing Address - Fax:631-425-0653
Practice Address - Street 1:1890 NEW YORK AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-2904
Practice Address - Country:US
Practice Address - Phone:631-427-6920
Practice Address - Fax:631-425-0653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty