Provider Demographics
NPI:1376742288
Name:TWIN CITY CHIROPRACTIC
Entity Type:Organization
Organization Name:TWIN CITY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:LOREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BRUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-693-5646
Mailing Address - Street 1:510 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-4300
Mailing Address - Country:US
Mailing Address - Phone:716-693-5646
Mailing Address - Fax:716-693-2667
Practice Address - Street 1:510 OLIVER ST
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-4300
Practice Address - Country:US
Practice Address - Phone:716-693-5646
Practice Address - Fax:716-693-2667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2014-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009649111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1376742288OtherNPI
NYC09649-7OtherWORKER'S COMP
NYJ100057652Medicare PIN
NYC09649-7OtherWORKER'S COMP