| NPI | 1417207028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD JOHN WALLACE President 631-360-0170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2012-09-12 |
| Last Update Date | 2012-11-19 |