Healthcare Provider Details

I. General information

NPI: 1093292534
Provider Name (Legal Business Name): JOEL DAVID NEWBURG D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 W LAKE RD
DUNKIRK NY
14048-9613
US

IV. Provider business mailing address

PO BOX 70
DUNKIRK NY
14048-0070
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-2229
  • Fax:
Mailing address:
  • Phone: 716-366-2229
  • Fax: 716-366-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number013031-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: