Provider Demographics
NPI:1568462018
Name:CONSCHAFTER, GARY WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:WILLIAM
Last Name:CONSCHAFTER
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 1:337 CLEVELAND DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1920
Mailing Address - Country:US
Mailing Address - Phone:716-833-6225
Mailing Address - Fax:716-833-6222
Practice Address - Street 1:337 CLEVELAND DR
Practice Address - Street 2:SUITE 1
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215-1920
Practice Address - Country:US
Practice Address - Phone:716-833-6225
Practice Address - Fax:716-833-6222
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NYX2333111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT26062Medicare UPIN
NY078891Medicare ID - Type Unspecified