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General NPI Number Information
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NPI Number | 1912220146
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Entity Type | Organization
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Legal Business Name | ONTARIO FAMILY CHIROPRACTIC P.C.
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 1422 NYS ROUTE 104
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City | ONTARIO
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State | NY
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Zip | 14519-9561
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Country | US
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Telephone | 315-524-2835
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Fax | 315-524-3164
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Provider Business Mailing Address
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Address Line | 1422 NYS ROUTE 104
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City | ONTARIO
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State | NY
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Zip | 14519-9561
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Country | US
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Telephone | 315-524-2835
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Fax | 315-524-3164
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Authorized Official
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Title or Position | CHIROPRACTOR/OWNER
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Name | DR. TEON STEVEN KOWALYK
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Credential | D.C.
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Telephone | 315-524-2835
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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 | X011472-1
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License Number State | NY
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