Provider Demographics
NPI:1356673461
Name:CIURA, BRENDAN J (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:J
Last Name:CIURA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 CENTRAL AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LANCASATER
Mailing Address - State:NY
Mailing Address - Zip Code:14086
Mailing Address - Country:US
Mailing Address - Phone:716-683-6615
Mailing Address - Fax:716-685-2052
Practice Address - Street 1:450 CENTRAL AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086
Practice Address - Country:US
Practice Address - Phone:716-683-6615
Practice Address - Fax:716-685-2052
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-01
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011823-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
J300034608Medicare PIN