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General NPI Number Information
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NPI Number | 1124338074
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Entity Type | Organization
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Legal Business Name | BUFFALO FAMILY CHIROPRACTIC WELLNESS, P.C.
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 06/10/2015
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Provider Practice Location Address
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Address Line | 369 DELAWARE AVE
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City | BUFFALO
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State | NY
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Zip | 14202-1601
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Country | US
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Telephone | 716-854-1563
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Fax | 716-854-1567
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Provider Business Mailing Address
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Address Line | 369 DELAWARE AVE
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City | BUFFALO
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State | NY
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Zip | 14202-1601
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Country | US
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Telephone | 716-854-1563
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Fax | 716-854-1567
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Authorized Official
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Title or Position | CHIROPRACTOR/PRESIDENT
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Name | KATHLEEN HENNEBERGER
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Credential | D.C.
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Telephone | 716-854-1563
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | X0117321
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License Number State | NY
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