1386960631 NPI number — OPTIMUM CHIROPRACTIC OF WESTERN NEW YORK, PLLC

Table of content: (NPI 1386960631)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386960631 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:
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:
1386960631
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2875 UNION ROAD
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:
14227-1461
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-833-1926
Provider Business Mailing Address Fax Number:
716-681-9456

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:
14227-1461
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:
716-681-9456
Provider Enumeration Date:
04/12/2010

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 MEMBER
Authorized Official Telephone Number:
716-833-1926

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , 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)





Copyright © 2007-2025 www.npivalidator.com