Individual
DR. JOHN WALLMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
2805 VETERANS MEMORIAL HWY, STE 8, RONKONKOMA, NY 11779-7680
(631) 440-7008
Mailing address
2805 VETERANS MEMORIAL HWY, STE 8, RONKONKOMA, NY 11779-7680
(631) 440-7008
Taxonomy
Speciality
Code
Description
License number
State
111NN1001X
Nutrition Chiropractor
1329
MA
111NN1001X
Nutrition Chiropractor
Primary
2887
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1329
MASSACHUSETTS LICENSE
MA
01
—
227986
NEW YORK WORKERS COMPENSATION
NY
01
—
2887
CHIROPRACTIC LICENSE
NY
01
—
625080
CIGNA PIN
MA
01
—
798258
TUFTS PROVIDER #
MA
01
—
Y35962
BC/BS
MA
Enumeration date
04/12/2012
Last updated
04/08/2016
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