IndividualActive
Joseph Russo, CHIROPRACTOR
NPI 1053393884 · Sports Physician Chiropractor · Massapequa Park, NY
Provider details
- NPI number
- 1053393884
- Entity type
- Individual
- Primary specialty
- Sports Physician ChiropractorChiropractic Providers
- Credential
- CHIROPRACTOR
- Sex
- Male
- Sole proprietor
- Yes
- License
- X00003447 (NY)
Specialties & taxonomies
Chiropractic Providers
Practice location
500 Park Blvd
Massapequa Park, NY 11762-2742
Phone: (516) 798-8363
Fax: (516) 798-8586
Approximate (ZIP-level) locationGet directions
Mailing address
500 Park Blvd
Massapequa Park, NY 11762-3042
Registry dates
- Enumerated
- 2005-11-17
- Last updated
- 2012-10-10
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.