=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265567358
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER MARIE MONIN D.C.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 656 ELMWOOD AVE
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14222-1836
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-883-0515
-----------------------------------------------------
Fax | 716-883-8764
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 509 MEADOW DR
-----------------------------------------------------
City | WEST SENECA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14224-1517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-867-8784
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X0111871
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------