1225363344 NPI number — OPTIMUM CHIROPRACTIC OF WESTERN NEW YORK, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225363344 NPI number — OPTIMUM CHIROPRACTIC OF WESTERN NEW YORK, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OPTIMUM CHIROPRACTIC OF WESTERN NEW YORK, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225363344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2875 UNION RD
Provider Second Line Business Mailing Address:
SUITE 351
Provider Business Mailing Address City Name:
CHEEKTOWAGA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14227-1465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-833-1926
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2875 UNION RD
Provider Second Line Business Practice Location Address:
SUITE 351
Provider Business Practice Location Address City Name:
CHEEKTOWAGA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14227-1465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-833-1926
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MONDSCHEIN
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
D
Authorized Official Title or Position:
SOLE PROPRIETOR
Authorized Official Telephone Number:
716-833-1926

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  011746 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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