Provider Demographics
NPI:1871593822
Name:GEFALLER, RONALD WARREN (DC)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:WARREN
Last Name:GEFALLER
Suffix:
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 1:3959 N BUFFALO ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1841
Mailing Address - Country:US
Mailing Address - Phone:716-667-6800
Mailing Address - Fax:716-539-5258
Practice Address - Street 1:3959 N BUFFALO ST
Practice Address - Street 2:SUITE 16
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1841
Practice Address - Country:US
Practice Address - Phone:716-667-6800
Practice Address - Fax:716-539-5258
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-29
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0003398111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU55480Medicare UPIN
NYU55480Medicare UPIN