Provider Demographics
NPI:1851470660
Name:ANDREW R. FORELLI DC PC
Entity Type:Organization
Organization Name:ANDREW R. FORELLI DC PC
Other - Org Name:FORELLI FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:R
Authorized Official - Last Name:FORELLI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:631-424-0163
Mailing Address - Street 1:54 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2813
Mailing Address - Country:US
Mailing Address - Phone:631-424-0163
Mailing Address - Fax:631-425-2602
Practice Address - Street 1:54 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2813
Practice Address - Country:US
Practice Address - Phone:631-424-0163
Practice Address - Fax:631-425-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006484111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty