Provider Demographics
NPI:1184923815
Name:WNY MUSCLE & JOINT PERFORMANCE CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:WNY MUSCLE & JOINT PERFORMANCE CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:PHIPPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:716-629-3100
Mailing Address - Street 1:390 S YOUNGS RD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7030
Mailing Address - Country:US
Mailing Address - Phone:716-629-3100
Mailing Address - Fax:716-629-3199
Practice Address - Street 1:390 S YOUNGS RD
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7030
Practice Address - Country:US
Practice Address - Phone:716-629-3100
Practice Address - Fax:716-629-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011953-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty