Provider Demographics
NPI:1245711829
Name:ENDWELL CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:ENDWELL CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRAZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:607-754-4844
Mailing Address - Street 1:412 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-4926
Mailing Address - Country:US
Mailing Address - Phone:607-754-4844
Mailing Address - Fax:607-754-6812
Practice Address - Street 1:412 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-4926
Practice Address - Country:US
Practice Address - Phone:607-754-4844
Practice Address - Fax:607-754-6812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009352-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty