Provider Demographics
NPI:1790078160
Name:CHIROPRACTIC CARE OF LONG ISLAND P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC CARE OF LONG ISLAND P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-673-5433
Mailing Address - Street 1:214 WALL ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-7804
Mailing Address - Country:US
Mailing Address - Phone:631-673-5433
Mailing Address - Fax:631-673-5435
Practice Address - Street 1:214 WALL ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-7804
Practice Address - Country:US
Practice Address - Phone:631-673-5433
Practice Address - Fax:631-673-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011878111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty