Healthcare Provider Details

I. General information

NPI: 1154497121
Provider Name (Legal Business Name): GRAND ISLAND CHIROPRACTIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2283 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1819
US

IV. Provider business mailing address

2283 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-1819
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-2222
  • Fax: 866-907-6157
Mailing address:
  • Phone: 716-773-2222
  • Fax: 866-907-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009041
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS J NOTARO
Title or Position: CHIROPRACTOR OWNER
Credential: D.C.
Phone: 716-773-2222