Provider Demographics
NPI:1780730721
Name:DANIEL G JIVIDEN, DC CHIROPRACTIC SERVICES, PC
Entity type:Organization
Organization Name:DANIEL G JIVIDEN, DC CHIROPRACTIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:JIVIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-652-3254
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-0412
Mailing Address - Country:US
Mailing Address - Phone:585-352-3254
Mailing Address - Fax:
Practice Address - Street 1:66 NICHOLS ST
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2192
Practice Address - Country:US
Practice Address - Phone:585-352-3254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0077641111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11771BMedicare ID - Type Unspecified