Provider Demographics
NPI:1982361838
Name:SIWY, BRANDON M (DOC)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:M
Last Name:SIWY
Suffix:
Gender:M
Credentials:DOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 COVE HOLW
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-3937
Mailing Address - Country:US
Mailing Address - Phone:716-392-1836
Mailing Address - Fax:
Practice Address - Street 1:3083 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-1933
Practice Address - Country:US
Practice Address - Phone:716-894-2959
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-25
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013534111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor