Provider Demographics
NPI:1114271756
Name:ISLIP CHIROPRACTIC PC
Entity type:Organization
Organization Name:ISLIP CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-647-8324
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-0027
Mailing Address - Country:US
Mailing Address - Phone:631-647-8324
Mailing Address - Fax:631-647-8324
Practice Address - Street 1:99 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2538
Practice Address - Country:US
Practice Address - Phone:631-647-8324
Practice Address - Fax:631-647-8324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty