Provider Demographics
NPI:1528752458
Name:FUNCTIONAL LIVING CHIROPRACTIC, PLLC
Entity type:Organization
Organization Name:FUNCTIONAL LIVING CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-469-1571
Mailing Address - Street 1:2132 FIVE MILE LINE RD STE E
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2209
Mailing Address - Country:US
Mailing Address - Phone:585-469-1571
Mailing Address - Fax:585-203-1741
Practice Address - Street 1:2132 FIVE MILE LINE RD STE E
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2209
Practice Address - Country:US
Practice Address - Phone:585-469-1571
Practice Address - Fax:585-203-1741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty