Healthcare Provider Details

I. General information

NPI: 1356673461
Provider Name (Legal Business Name): BRENDAN J CIURA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2010
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CENTRAL AVE. SUITE 102
LANCASTER NY
14086
US

IV. Provider business mailing address

450 CENTRAL AVE. SUITE 102
LANCASATER NY
14086
US

V. Phone/Fax

Practice location:
  • Phone: 716-683-6615
  • Fax: 716-685-2052
Mailing address:
  • Phone: 716-683-6615
  • Fax: 716-685-2052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX011823-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: