Provider Demographics
NPI:1023135332
Name:CAPURSO, CHRISTINE ANNE (LAC, DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ANNE
Last Name:CAPURSO
Suffix:
Gender:F
Credentials:LAC, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 E MAIN ST STE 115
Mailing Address - Street 2:
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3121
Mailing Address - Country:US
Mailing Address - Phone:631-419-6300
Mailing Address - Fax:888-880-9756
Practice Address - Street 1:475 E MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3121
Practice Address - Country:US
Practice Address - Phone:631-419-6300
Practice Address - Fax:888-880-9756
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008494111N00000X
NY006493171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX1B721Medicare ID - Type UnspecifiedMEDICARE NUMBER