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General NPI Number Information
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NPI Number | 1295782795
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Entity Type | Organization
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Legal Business Name | CHIROPRACTIC LIFESTYLE FAMILY PRACTICE PC
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Dates
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Enumeration Date | 05/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4796 MAIN ST
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City | SNYDER
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State | NY
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Zip | 14226-4020
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Country | US
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Telephone | 716-635-9742
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Fax | 716-635-9744
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Provider Business Mailing Address
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Address Line | 4796 MAIN ST
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City | SNYDER
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State | NY
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Zip | 14226-4020
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Country | US
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Telephone | 716-635-9742
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Fax | 716-635-9744
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRIAN POKORSKI
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Credential | D.C.
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Telephone | 716-635-9742
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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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