| NPI | 1245646371 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WALLACE Owner 631-338-7860 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 101Y00000X Counselor |
| 171100000X Acupuncturist | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2016-04-18 |