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General NPI Number Information
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NPI Number | 1134049026
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Entity Type | Organization
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Legal Business Name | SYRACUSE FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/20/2026
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Last Update Date | 07/20/2026
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Provider Practice Location Address
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Address Line | 4000 MEDICAL CENTER DRIVE SUITE 301
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City | FAYETTEVILLE
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State | NY
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Zip | 13066
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Country | US
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Telephone | 315-761-6311
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Fax |
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Provider Business Mailing Address
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Address Line | 7810 BULL ST
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City | BRIDGEPORT
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State | NY
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Zip | 13030-8418
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Country | US
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Telephone | 315-761-6311
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. PETER GEORGE NICKLESS
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Credential | DC
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Telephone | 315-761-6311
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number |
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License Number State |
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