Provider Demographics
NPI:1093957722
Name:ADVANCE CHIROPRACTIC-WILSON P.C.
Entity Type:Organization
Organization Name:ADVANCE CHIROPRACTIC-WILSON P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:MONTELEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-754-7120
Mailing Address - Street 1:PO BOX 890
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NY
Mailing Address - Zip Code:14172-0890
Mailing Address - Country:US
Mailing Address - Phone:716-751-3939
Mailing Address - Fax:716-751-0130
Practice Address - Street 1:286 YOUNG ST.
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NY
Practice Address - Zip Code:14172-0890
Practice Address - Country:US
Practice Address - Phone:716-751-3939
Practice Address - Fax:716-751-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX007082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1161Medicare PIN