Provider Demographics
NPI:1205917663
Name:BURGIO, PHYLLIS MARIE (DC)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:MARIE
Last Name:BURGIO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 TRANSIT RD
Mailing Address - Street 2:SUITE #7
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2606
Mailing Address - Country:US
Mailing Address - Phone:716-688-8856
Mailing Address - Fax:
Practice Address - Street 1:6161 TRANSIT RD
Practice Address - Street 2:SUITE #7
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2606
Practice Address - Country:US
Practice Address - Phone:716-688-8856
Practice Address - Fax:716-688-9323
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005436-2111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT83112Medicare UPIN
NY056131Medicare ID - Type Unspecified