Individual provider · Type 1 NPI
Gary P. Dibenedetto, DC
Chiropractor · Port Jefferson Station, NY
NPI number
1790890580
Active
Practice location
298 Canal Rd
Port Jefferson Station, NY 11776
Fax (631) 928-0253
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Chiropractor Primary | 111N00000X | X006475 (NY) |
Chiropractor: 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.
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About NPI 1790890580
Gary P. Dibenedetto, DC's National Provider Identifier is 1790890580, issued on Aug 20, 2006. The primary taxonomy on file is Chiropractor (111N00000X), and the practice location is in Port Jefferson Station, NY. The record was last updated on Dec 12, 2008.