Provider Demographics
NPI:1659648772
Name:HPRDC CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:HPRDC CHIROPRACTIC PLLC
Other - Org Name:POWER ON WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-580-0040
Mailing Address - Street 1:31 BALIN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11720-1123
Mailing Address - Country:US
Mailing Address - Phone:631-580-0040
Mailing Address - Fax:631-928-8340
Practice Address - Street 1:31 BALIN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11720-1123
Practice Address - Country:US
Practice Address - Phone:631-580-0040
Practice Address - Fax:631-928-8340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-17
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005445-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty