Individual
DR. EUGENE RUSSELL FAILLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.C.
Contact information
Practice address
3075 VETERANS MEMORIAL HWY STE 101, RONKONKOMA, NY 11779-7600
(631) 708-5573
(631) 619-6543
Mailing address
64 SUYDAM LN, BAYPORT, NY 11705-2107
(631) 472-2696
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
X007958
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
X007958
NYS LICENSE
NY
Enumeration date
04/21/2006
Last updated
12/10/2018
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