Provider Demographics
NPI:1851579718
Name:WHEATFIELD FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:WHEATFIELD FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SKOWRONEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-695-2225
Mailing Address - Street 1:2728 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-4587
Mailing Address - Country:US
Mailing Address - Phone:716-695-2225
Mailing Address - Fax:716-695-1181
Practice Address - Street 1:2728 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-4587
Practice Address - Country:US
Practice Address - Phone:716-695-2225
Practice Address - Fax:716-695-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009754-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U92258Medicare UPIN
DD2743Medicare PIN