Provider Demographics
NPI:1588908503
Name:CORRECTIVE CHIROPRACTIC WELLNESS LLC
Entity type:Organization
Organization Name:CORRECTIVE CHIROPRACTIC WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLEN
Authorized Official - Last Name:HECHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-825-7100
Mailing Address - Street 1:498 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2406
Mailing Address - Country:US
Mailing Address - Phone:516-825-7100
Mailing Address - Fax:516-825-7102
Practice Address - Street 1:498 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2406
Practice Address - Country:US
Practice Address - Phone:516-825-7100
Practice Address - Fax:516-825-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8645111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX6N991Medicare PIN
NYU97919Medicare UPIN