Provider Demographics
NPI:1386042448
Name:STEFANOWICZ, ERIC TIMOTHY (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:TIMOTHY
Last Name:STEFANOWICZ
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 1:320 PORTER AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1032
Mailing Address - Country:US
Mailing Address - Phone:315-569-1281
Mailing Address - Fax:
Practice Address - Street 1:320 PORTER AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1032
Practice Address - Country:US
Practice Address - Phone:315-569-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-05
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012609111N00000X, 111NR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0200XChiropractic ProvidersChiropractorRadiology
No111N00000XChiropractic ProvidersChiropractor