Ronkonkoma Chiropractic PC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

110948 Issued in NY

Legal business name

RONKONKOMA CHIROPRACTIC PC

Practice address

3075 Veterans Memorial Hwy
Ronkonkoma, NY 11779-7667

Phone

(631) 472-2696

NPI assigned

Jun 20, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eugene Russell Faillace, DC

Title

President

Phone

(631) 472-2696

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1469664000000",
    "number": "1649620709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 VETERANS MEMORIAL HWY",
            "address_2": "SUITE 101",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797667",
            "telephone_number": "631-472-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 VETERANS MEMORIAL HWY",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "117797667",
            "telephone_number": "631-472-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RONKONKOMA CHIROPRACTIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-20",
        "last_updated": "2016-07-28",
        "status": "A",
        "authorized_official_last_name": "FAILLACE",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "RUSSELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "631-472-2696",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "110948",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "X007958",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Chiropractor in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.