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General NPI Number Information
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NPI Number | 1871865212
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Entity Type | Organization
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Legal Business Name | GILLEZEAU CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 02/01/2012
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Last Update Date | 02/01/2012
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Provider Practice Location Address
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Address Line | 3383 BIG TREE RD
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City | HAMBURG
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State | NY
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Zip | 14075-1703
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Country | US
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Telephone | 716-980-6107
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Fax |
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Provider Business Mailing Address
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Address Line | 3383 BIG TREE RD
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City | HAMBURG
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State | NY
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Zip | 14075-1703
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Country | US
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Telephone | 716-980-6107
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL M GILLEZEAU
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Credential | D.C.
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Telephone | 716-980-6107
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 012028
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License Number State | NY
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