MEDICARE: PB&J CHIROPRACTIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1255804076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PB&J CHIROPRACTIC

Provider Business Mailing Address
First Line	:	149 VIRGIL AVE UPPR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1805
Country	:	US
Telephone Number	:	716-228-2165
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 VIRGIL AVE UPPR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14216-1805
Country	:	US
Telephone Number	:	716-228-2165
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DOCTOR OF CHIROPRACTIC
Name	:	DR. NICHOLAS R JONES
Credential	:	DC
Telephone Number	:	716-228-2165

Provider Enumeration Date	:	01/03/2019
Last Update Date	:	01/18/2019

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