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General NPI Number Information
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NPI Number | 1447618277
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Entity Type | Organization
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Legal Business Name | PARKER CHIROPRACTIC
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 1564 PARKER BLVD
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City | TONAWANDA
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State | NY
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Zip | 14150-8730
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Country | US
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Telephone | 207-240-3782
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Fax |
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Provider Business Mailing Address
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Address Line | 1564 PARKER BLVD
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City | TONAWANDA
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State | NY
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Zip | 14150-8730
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Country | US
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Telephone | 207-240-3782
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Fax |
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Authorized Official
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Title or Position | OWNER/CHIROPRACTOR
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Name | HEIDI BONDERUD
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Credential | D.C.
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Telephone | 207-240-3782
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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 | X012440-1
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License Number State | NY
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