# GRAND ISLAND CHIROPRACTIC PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154497121
- **Authorized official:** DR. THOMAS J NOTARO D.C. (CHIROPRACTOR OWNER)
- **Authorized official phone:** (716) 773-2222

## Contact information

- **Practice address:** 2283 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072-1819
- **Practice address phone:** (716) 773-2222
- **Practice address fax:** (866) 907-6157
- **Mailing address:** 2283 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072-1819
- **Mailing address phone:** (716) 773-2222
- **Mailing address fax:** (866) 907-6157

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X009041 | NY | Yes |

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000225223004 | BLUE CROSS AND BLUE SHIEL | NY |
| 01 | — | 5801989 | GHI | NY |
| 01 | — | 8890392 | INDEPENDENT HEALTH ID | NY |
| 01 | — | HC09041-7 | WORKERS COMPENSATION | NY |
| 01 | — | P00305508 | RAILROAD MEDICARE ID | NY |