Healthcare Provider Details

I. General information

NPI: 1679545057
Provider Name (Legal Business Name): PAWEL J PYRDA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 MAIN ST
WHITESBORO NY
13492-1022
US

IV. Provider business mailing address

572 MAIN ST
NEW YORK MILLS NY
13417-1449
US

V. Phone/Fax

Practice location:
  • Phone: 315-733-4325
  • Fax: 315-736-2990
Mailing address:
  • Phone: 315-736-2793
  • Fax: 315-736-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: