Provider Demographics
NPI:1912220146
Name:ONTARIO FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:ONTARIO FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TEON
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:KOWALYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:315-524-2835
Mailing Address - Street 1:1422 NYS ROUTE 104
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9561
Mailing Address - Country:US
Mailing Address - Phone:315-524-2835
Mailing Address - Fax:315-524-3164
Practice Address - Street 1:1422 NYS ROUTE 104
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9561
Practice Address - Country:US
Practice Address - Phone:315-524-2835
Practice Address - Fax:315-524-3164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-02
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011472-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty