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General NPI Number Information
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NPI Number | 1316491186
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Entity Type | Individual
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Provider Name | STEPHEN VICTOR GLADYSZ D.C.
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Gender | Male
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Dates
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Enumeration Date | 08/10/2016
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 767 MINERAL SPRINGS RD
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City | WEST SENECA
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State | NY
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Zip | 14224-1053
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Country | US
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Telephone | 716-316-5398
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Fax |
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Provider Business Mailing Address
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Address Line | 80 SNYDERWOODS CT
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City | AMHERST
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State | NY
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Zip | 14226-2562
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Country | US
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Telephone | 716-316-5398
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | X012745-1
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License Number State | NY
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