Provider Demographics
NPI:1952730525
Name:MORALES, WILFREDO III (DC)
Entity Type:Individual
Prefix:DR
First Name:WILFREDO
Middle Name:
Last Name:MORALES
Suffix:III
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 1:352 ROSEVALE AVE
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3036
Mailing Address - Country:US
Mailing Address - Phone:631-774-5241
Mailing Address - Fax:631-619-1895
Practice Address - Street 1:352 ROSEVALE AVE
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3036
Practice Address - Country:US
Practice Address - Phone:631-774-5241
Practice Address - Fax:631-737-3356
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX012434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor