Organization
LIGHTHOUSE CHIROPRACTIC, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD TYSZKOWSKI (PRESIDENT)
(401) 490-0494
Entity
Organization
Contact information
Practice address
717 ALLENS AVE, PROVIDENCE, RI 02905-5412
(401) 751-6568
Mailing address
PO BOX 9117, WARWICK, RI 02889-0117
(401) 751-6568
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
346
RI
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD14078
RI
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
MD14078
RI
Other
Enumeration date
04/07/2010
Last updated
11/14/2012
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