Active NPI
John Wallman, DC
- Nutrition Chiropractor
- Ronkonkoma, NY
National Provider Identifier
1942567235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutrition Chiropractor
- License
- 2887
- Practice address
- 2805 Veterans Memorial Hwy
Ste 8
Ronkonkoma, NY 11779-7680 - Phone
- (631) 440-7008
- NPI assigned
- Apr 12, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nutrition Chiropractor | 111NN1001X | 2887 | NY | Primary |
| Nutrition Chiropractor | 111NN1001X | 1329 | MA |
Addresses
Primary practice location
2805 Veterans Memorial Hwy
Ste 8
Ronkonkoma, NY 11779-7680
Mailing address
2805 Veterans Memorial Hwy
Ste 8
Ronkonkoma, NY 11779-7680
Phone (631) 440-7008
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Y35962 | Other | MA | BC/BS |
| 2887 | Other | NY | CHIROPRACTIC LICENSE |
| 1329 | Other | MA | MASSACHUSETTS LICENSE |
| 625080 | Other | MA | CIGNA PIN |
| 798258 | Other | MA | TUFTS PROVIDER # |
| 227986 | Other | NY | NEW YORK WORKERS COMPENSATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2887 | NY | MD | Nutrition Chiropractor |
| 002887 | NY | MD | Internal Medicine Physician |
| 1329 | MA | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1334188800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1460073600000",
"number": "1942567235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 VETERANS MEMORIAL HWY",
"address_2": "STE 8",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797680",
"telephone_number": "631-440-7008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 VETERANS MEMORIAL HWY",
"address_2": "STE 8",
"city": "RONKONKOMA",
"state": "NY",
"postal_code": "117797680",
"telephone_number": "631-440-7008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLMAN",
"first_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-04-12",
"last_updated": "2016-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "111NN1001X",
"taxonomy_group": "",
"desc": "Chiropractor, Nutrition",
"state": "NY",
"license": "2887",
"primary": true
},
{
"code": "111NN1001X",
"taxonomy_group": "",
"desc": "Chiropractor, Nutrition",
"state": "MA",
"license": "1329",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS",
"identifier": "Y35962",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHIROPRACTIC LICENSE",
"identifier": "2887",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MASSACHUSETTS LICENSE",
"identifier": "1329",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA PIN",
"identifier": "625080",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS PROVIDER #",
"identifier": "798258",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK WORKERS COMPENSATION",
"identifier": "227986",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ronkonkoma, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 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.