Provider Demographics
NPI:1538291091
Name:LIFE FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:LIFE FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAGLIONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-224-7855
Mailing Address - Street 1:250 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-3415
Mailing Address - Country:US
Mailing Address - Phone:631-224-7855
Mailing Address - Fax:631-224-7850
Practice Address - Street 1:250 MAIN ST
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-3415
Practice Address - Country:US
Practice Address - Phone:631-224-7855
Practice Address - Fax:631-224-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXAWGV1Medicare ID - Type Unspecified