Provider Demographics
NPI:1710251160
Name:CHIROCORE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CHIROCORE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BENCIVENGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-343-6661
Mailing Address - Street 1:1350 HICKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-1219
Mailing Address - Country:US
Mailing Address - Phone:516-343-6661
Mailing Address - Fax:516-798-5652
Practice Address - Street 1:1350 HICKSVILLE RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-1219
Practice Address - Country:US
Practice Address - Phone:516-343-6661
Practice Address - Fax:516-798-5652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012125111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty