Provider Demographics
NPI:1245532415
Name:LONG ISLAND CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:LONG ISLAND CHIROPRACTIC P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:D'BRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-609-0890
Mailing Address - Street 1:977 GLEN COVE AVENUE
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545
Mailing Address - Country:US
Mailing Address - Phone:516-609-0890
Mailing Address - Fax:516-609-0893
Practice Address - Street 1:977 GLEN COVE AVENUE
Practice Address - Street 2:
Practice Address - City:GLEN HEAD
Practice Address - State:NY
Practice Address - Zip Code:11545
Practice Address - Country:US
Practice Address - Phone:516-609-0890
Practice Address - Fax:516-609-0893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0055941111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty