Provider Demographics
NPI:1093688996
Name:DALLY, JEROAN W (DC)
Entity type:Individual
Prefix:DR
First Name:JEROAN
Middle Name:W
Last Name:DALLY
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 1:173 WEIR ST
Mailing Address - Street 2:
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-7629
Mailing Address - Country:US
Mailing Address - Phone:917-325-1323
Mailing Address - Fax:
Practice Address - Street 1:173 WEIR ST
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-7629
Practice Address - Country:US
Practice Address - Phone:917-325-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-26
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor