MEDICARE: TONAWANDA CHIROPRACTIC, P.L.L.C.

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	:	1518625425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TONAWANDA CHIROPRACTIC, P.L.L.C.

Provider Business Mailing Address
First Line	:	1201 COLVIN BLVD STE 2A
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-490-0210
Fax Number	:	716-954-0208

Provider Business Practice Location Address
First Line	:	1201 COLVIN BLVD STE 2A
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14223-1936
Country	:	US
Telephone Number	:	716-490-0210
Fax Number	:	716-954-0208

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA JOHN NELSON
Credential	:	DC
Telephone Number	:	716-490-0210

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	12/08/2021

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