Provider Demographics
NPI:1720375488
Name:3 VILLAGE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:3 VILLAGE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-675-2910
Mailing Address - Street 1:128 OLD TOWN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2064
Mailing Address - Country:US
Mailing Address - Phone:631-675-2910
Mailing Address - Fax:631-675-2912
Practice Address - Street 1:128 OLD TOWN RD
Practice Address - Street 2:SUITE C
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2064
Practice Address - Country:US
Practice Address - Phone:631-675-2910
Practice Address - Fax:631-675-2912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-01
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty