Provider Demographics
NPI:1457525172
Name:ADVANCE CHIROPRACTIC
Entity Type:Organization
Organization Name:ADVANCE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:MONTELEONE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:716-283-7979
Mailing Address - Street 1:820 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301
Mailing Address - Country:US
Mailing Address - Phone:716-283-7979
Mailing Address - Fax:716-283-1336
Practice Address - Street 1:820 MAIN STREET
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301
Practice Address - Country:US
Practice Address - Phone:716-283-7979
Practice Address - Fax:716-283-1336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-006652-1111N00000X
NYX007082-3111N00000X
NYX006652-4111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0939Medicare PIN