Healthcare Provider Details

I. General information

NPI: 1629598743
Provider Name (Legal Business Name): BRIAN TRAVIS GELLER DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 10/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GEORGE KARL BLVD
WILLIAMSVILLE NY
14221-7183
US

IV. Provider business mailing address

164 STILLWELL AVE UPPR
KENMORE NY
14217-2134
US

V. Phone/Fax

Practice location:
  • Phone: 716-218-1000
  • Fax:
Mailing address:
  • Phone: 917-916-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number012969
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: