Provider Demographics
NPI:1689211310
Name:SPINE ALIGN CHIROPRACTIC WELLNESS, LLC
Entity Type:Organization
Organization Name:SPINE ALIGN CHIROPRACTIC WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CRACCHIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-395-3800
Mailing Address - Street 1:2300 GEORGE URBAN BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1958
Mailing Address - Country:US
Mailing Address - Phone:716-395-3800
Mailing Address - Fax:716-395-3802
Practice Address - Street 1:2300 GEORGE URBAN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1958
Practice Address - Country:US
Practice Address - Phone:716-395-3800
Practice Address - Fax:716-395-3802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty