Doctor Name: | DR. GARY P DIBENEDETTO |
NPI Number: | 1790890580 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DC |
License Number: | X006475 |
Business Practice Address: | 298 Canal Rd Port Jefferson Station, NY - 11776 |
Business Phone Number: | 6319280192 |
Business Fax Number: | 6319280253 |
Mailing Address: | 298 Canal Rd, PORT JEFFERSON STATION |
State: | NY |
Postal Code: | 11776 |
Phone Number: | 6319280192 |
Fax Number: | 6319280253 |
NPI Enumeration Date: | 08/20/2006 |
NPI Last Update Date: | 12/12/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 111N00000X |
License Number: | X006475 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Chiropractic Providers |
Taxonomy Classification: | Chiropractor |
Taxonomy Specialization: | |
Taxonomy Definition: | A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |