Provider Demographics
NPI:1699077008
Name:SOUTH MAIN CHIROPRACTIC,P.C.
Entity type:Organization
Organization Name:SOUTH MAIN CHIROPRACTIC,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-482-8824
Mailing Address - Street 1:340 MONTAUK HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4437
Mailing Address - Country:US
Mailing Address - Phone:631-482-8824
Mailing Address - Fax:631-482-8827
Practice Address - Street 1:340 MONTAUK HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4437
Practice Address - Country:US
Practice Address - Phone:631-482-8824
Practice Address - Fax:631-482-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-18
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0082981111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty