Healthcare Provider Details

I. General information

NPI: 1104868132
Provider Name (Legal Business Name): ROXANNE M DZIEDZIC DC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 BROADWAY ST
ALDEN NY
14004-1324
US

IV. Provider business mailing address

13305 BROADWAY ST
ALDEN NY
14004-1324
US

V. Phone/Fax

Practice location:
  • Phone: 716-937-4577
  • Fax: 716-937-7535
Mailing address:
  • Phone: 716-937-4577
  • Fax: 716-937-7535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX008435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: