Provider Demographics
NPI:1003009507
Name:ELLICOTT SQUARE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ELLICOTT SQUARE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PIGNATORA
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:716-852-2696
Mailing Address - Street 1:2075 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1425
Mailing Address - Country:US
Mailing Address - Phone:716-852-2696
Mailing Address - Fax:716-852-2699
Practice Address - Street 1:2075 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14223-1425
Practice Address - Country:US
Practice Address - Phone:716-852-2696
Practice Address - Fax:716-852-2699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008944111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0175Medicare PIN
NYU70087Medicare UPIN