# LAKE CHIROPRACTIC, PLLC.

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

## Provider details

- **NPI number:** 1972803104
- **Authorized official:** DR. RONALD ROBERT BERNARDINI DC (CHIROPRACTOR/ PRESIDENT)
- **Authorized official phone:** (631) 981-1333

## Contact information

- **Practice address:** 201 PORTION RD, SUITE A, LAKE RONKONKOMA, NY 11779-4172
- **Practice address phone:** (631) 981-1333
- **Practice address fax:** (631) 981-6766
- **Mailing address:** 201 PORTION RD, SUITE A, LAKE RONKONKOMA, NY 11779-4172
- **Mailing address phone:** (631) 981-1333
- **Mailing address fax:** (631) 981-6766

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X2929 | NY | Yes |

## Other

- **Enumeration date:** 10/21/2010
- **Last updated:** 10/21/2010