Provider Demographics
NPI:1841344314
Name:WRIGHT, DOUGLAS BRIAN (DC)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:BRIAN
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 WOODBINE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768
Mailing Address - Country:US
Mailing Address - Phone:631-754-3775
Mailing Address - Fax:631-754-3816
Practice Address - Street 1:75 WOODBINE AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768
Practice Address - Country:US
Practice Address - Phone:631-754-3775
Practice Address - Fax:631-754-3816
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX006025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
X37931OtherBCBS
0558142OtherAETNA
0558142OtherAETNA
U18103Medicare UPIN