Provider Demographics
NPI:1053818369
Name:ENVISION WELLNESS CHIROPRACTIC PC
Entity type:Organization
Organization Name:ENVISION WELLNESS CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TINARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:631-467-8224
Mailing Address - Street 1:1461 LAKELAND AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:BOHEMIA
Mailing Address - State:NY
Mailing Address - Zip Code:11716
Mailing Address - Country:US
Mailing Address - Phone:631-467-8224
Mailing Address - Fax:631-585-7575
Practice Address - Street 1:1461 LAKELAND AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716
Practice Address - Country:US
Practice Address - Phone:631-467-8224
Practice Address - Fax:631-585-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003397-1111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Multi-Specialty