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General NPI Number Information
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NPI Number | 1245711829
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Entity Type | Organization
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Legal Business Name | ENDWELL CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 08/22/2018
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Last Update Date | 08/22/2018
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Provider Practice Location Address
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Address Line | 412 E MAIN ST
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City | ENDICOTT
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State | NY
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Zip | 13760-4926
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Country | US
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Telephone | 607-754-4844
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Fax | 607-754-6812
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Provider Business Mailing Address
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Address Line | 412 E MAIN ST
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City | ENDICOTT
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State | NY
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Zip | 13760-4926
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Country | US
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Telephone | 607-754-4844
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Fax | 607-754-6812
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARTIN D BRAZINSKI
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Credential | DC
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Telephone | 607-754-4844
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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 | X009352-1
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License Number State | NY
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