MEDICARE: MISIAK CHIROPRACTIC PC

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	X-006733	NY

General Provider Information

NPI Number	:	1972814564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISIAK CHIROPRACTIC PC

Provider Business Mailing Address
First Line	:	1331 N FOREST RD
Second Line	:	STE 220
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-2198
Country	:	US
Telephone Number	:	716-639-3939
Fax Number	:	716-639-8338

Provider Business Practice Location Address
First Line	:	1331 N FOREST RD
Second Line	:	STE 220
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14221-2198
Country	:	US
Telephone Number	:	716-639-3939
Fax Number	:	716-639-8338

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW MARK MISIAK
Credential	:	DC
Telephone Number	:	716-639-3939

Provider Enumeration Date	:	06/29/2010
Last Update Date	:	06/29/2010

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