Provider Demographics
NPI:1720564586
Name:FORESTVILLE CHIROPRACTIC PC
Entity Type:Organization
Organization Name:FORESTVILLE CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS - MIERWZA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-965-4343
Mailing Address - Street 1:24 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14062-9803
Mailing Address - Country:US
Mailing Address - Phone:716-965-4343
Mailing Address - Fax:
Practice Address - Street 1:24 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14062-9803
Practice Address - Country:US
Practice Address - Phone:716-965-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-16
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty