MEDICARE: SOUTH BUFFALO CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X3781	NY

General Provider Information

NPI Number	:	1427235696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH BUFFALO CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1923 SENECA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14210-1852
Country	:	US
Telephone Number	:	716-822-2225
Fax Number	:	716-822-7078

Provider Business Practice Location Address
First Line	:	1923 SENECA ST
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14210-1852
Country	:	US
Telephone Number	:	716-822-2225
Fax Number	:	716-822-7078

Authorized Official
Title or Position	:	OWNER
Name	:	ANTHONY AMABILE
Credential	:	DC
Telephone Number	:	716-822-2225

Provider Enumeration Date	:	01/30/2008
Last Update Date	:	01/30/2008

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