=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497051437
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BULGER CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2011
-----------------------------------------------------
Last Update Date | 04/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4110 SAINT FRANCIS DR
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-818-3481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4110 SAINT FRANCIS DR
-----------------------------------------------------
City | HAMBURG
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14075-1723
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-818-3481
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER - CHIROPRACTOR
-----------------------------------------------------
Name | JENNIFER BULGER
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 716-818-3481
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 70011965
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------