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General NPI Number Information
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NPI Number | 1225363344
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Entity Type | Organization
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Legal Business Name | OPTIMUM CHIROPRACTIC OF WESTERN NEW YORK, PLLC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 10/07/2009
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Provider Practice Location Address
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Address Line | 2875 UNION RD SUITE 351
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City | CHEEKTOWAGA
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State | NY
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Zip | 14227-1465
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Country | US
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Telephone | 716-833-1926
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Fax |
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Provider Business Mailing Address
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Address Line | 2875 UNION RD SUITE 351
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City | CHEEKTOWAGA
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State | NY
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Zip | 14227-1465
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Country | US
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Telephone | 716-833-1926
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. KEITH D MONDSCHEIN
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Credential | D.C.
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Telephone | 716-833-1926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 011746
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License Number State | NY
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