Organization
LONG ISLAND CHIROPRACTIC & PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD JOHN WALLACE DC (PRESIDENT)
(631) 360-0170
Entity
Organization
Contact information
Practice address
20 GILBERT AVE, SUITE 201, SMITHTOWN, NY 11787
(631) 724-1991
(631) 724-1995
Mailing address
20 GILBERT AVE, SUITE 201, SMITHTOWN, NY 11787
(631) 724-1991
(631) 724-1995
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
225100000X
Physical Therapist
—
—
Other
Enumeration date
09/12/2012
Last updated
11/19/2012
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