# LONG ISLAND CHIROPRACTIC & PHYSICAL THERAPY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417207028
- **Authorized official:** DR. DONALD JOHN WALLACE DC (PRESIDENT)
- **Authorized official phone:** (631) 360-0170

## Contact information

- **Practice address:** 20 GILBERT AVE, SUITE 201, SMITHTOWN, NY 11787
- **Practice address phone:** (631) 724-1991
- **Practice address fax:** (631) 724-1995
- **Mailing address:** 20 GILBERT AVE, SUITE 201, SMITHTOWN, NY 11787
- **Mailing address phone:** (631) 724-1991
- **Mailing address fax:** (631) 724-1995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | — | Yes |
| 225100000X | Physical Therapist | — | — | — |

## Other

- **Enumeration date:** 09/12/2012
- **Last updated:** 11/19/2012