Provider Demographics
NPI:1982210555
Name:RIVERHEAD CHIROPRACTIC WELLNESS, PC
Entity Type:Organization
Organization Name:RIVERHEAD CHIROPRACTIC WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGDANSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-727-7200
Mailing Address - Street 1:160 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2198
Mailing Address - Country:US
Mailing Address - Phone:631-727-7200
Mailing Address - Fax:631-727-7252
Practice Address - Street 1:160 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2198
Practice Address - Country:US
Practice Address - Phone:631-727-7200
Practice Address - Fax:631-727-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-19
Last Update Date:2020-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty