# ISLAND CHIROPRACTIC WELLNESS P.C.

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

## Provider details

- **NPI number:** 1538391099
- **Authorized official:** DR. STEVEN MICHAEL GERVASIO D.C., M.S. (OWNER)
- **Authorized official phone:** (516) 541-8933

## Contact information

- **Practice address:** 5500 MERRICK RD, MASSAPEQUA, NY 11758-6231
- **Practice address phone:** (516) 541-8933
- **Mailing address:** 5500 MERRICK RD, MASSAPEQUA, NY 11758-6231
- **Mailing address phone:** (516) 541-8933

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NN1001X | Nutrition Chiropractor | X011710-1 | NY | Yes |

## Other

- **Enumeration date:** 08/18/2009
- **Last updated:** 08/18/2009