Provider Demographics
NPI:1265503098
Name:SCOTT A. CROCE DC PC
Entity Type:Organization
Organization Name:SCOTT A. CROCE DC PC
Other - Org Name:ERIE COUNTY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-847-1200
Mailing Address - Street 1:369 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1601
Mailing Address - Country:US
Mailing Address - Phone:716-847-1200
Mailing Address - Fax:716-847-1212
Practice Address - Street 1:369 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1601
Practice Address - Country:US
Practice Address - Phone:716-847-1200
Practice Address - Fax:716-847-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0084311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00224610004OtherBC-BS
NY8890191OtherIHA
XGR96OtherEMPIRE
NY00040705002OtherUNIVERA
NY8890191OtherIHA
NYAA1163Medicare ID - Type UnspecifiedGROUP
NY00040705002OtherUNIVERA