Provider Demographics
NPI:1063559953
Name:JAUCH, DAVID EDWIN JR (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EDWIN
Last Name:JAUCH
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 BRANTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226-4307
Mailing Address - Country:US
Mailing Address - Phone:716-465-5567
Mailing Address - Fax:
Practice Address - Street 1:5555 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5430
Practice Address - Country:US
Practice Address - Phone:716-631-2236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009402111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB7859Medicare UPIN