=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942329826
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STEVEN ROBERT PASSMORE D.C., M.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/29/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3495 BAILEY AVE 7TH FLOOR, B-WING
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14215-1129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-862-6060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 ROBINSON STREET SOUTH UNIT 6
-----------------------------------------------------
City | GRIMSBY
-----------------------------------------------------
State | ONTARIO
-----------------------------------------------------
Zip | L3M3C6
-----------------------------------------------------
Country | CA
-----------------------------------------------------
Telephone | 905-667-4215
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | CHIA-1184
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------