Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 012237 | NY |
NPI | 1003165762 |
---|---|
Provider Name | Dr. Juliana Marie Marciniak |
First Address | Cheektowaga, NY 14227-3113 |
Second Address | Buffalo, NY 14216-1705 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2012 |
Last Update Date | 29/10/2012 |