1780961904 NPI number — ANTHONY M. CARUSO, DC, PC

Table of content: RICHARD LEE BACKMAN MD (NPI 1528158151)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780961904 NPI number — ANTHONY M. CARUSO, DC, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTHONY M. CARUSO, DC, PC
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:
1780961904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/21/2011
NPI Reactivation Date:
08/17/2012

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2577 SHERIDAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TONAWANDA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14150-9411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-832-8888
Provider Business Mailing Address Fax Number:
716-832-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2577 SHERIDAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONAWANDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14150-9411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-832-8888
Provider Business Practice Location Address Fax Number:
716-832-0124
Provider Enumeration Date:
11/16/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARUSO
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CHIROPRACTOR/OWNER
Authorized Official Telephone Number:
716-832-8888

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  X005751 , 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)