=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114102662
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN DAVID STROM D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/03/2008
-----------------------------------------------------
Last Update Date | 01/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1498 ELLICOTT CREEK RD
-----------------------------------------------------
City | TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14150-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-694-8236
-----------------------------------------------------
Fax | 716-694-8236
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1498 ELLICOTT CREEK RD
-----------------------------------------------------
City | TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14150-2916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-694-8236
-----------------------------------------------------
Fax | 716-694-8236
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X006248-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 1525
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------