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General NPI Number Information
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NPI Number | 1831240845
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Entity Type | Organization
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Legal Business Name | O NEILL CHIROPRACTIC PC
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 616 POTOMAC AVE
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City | BUFFALO
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State | NY
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Zip | 14222-1214
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Country | US
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Telephone | 716-884-4450
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Fax | 716-881-1217
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Provider Business Mailing Address
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Address Line | 616 POTOMAC AVE
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City | BUFFALO
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State | NY
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Zip | 14222
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Country | US
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Telephone | 716-884-4450
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Fax | 716-881-1217
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRENCE PATRICK O NEILL
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Credential | DC
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Telephone | 716-884-4450
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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 | X009399-1
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License Number State | NY
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