Basic Information
| Provider Information | |||||||||
| NPI: | 1104189976 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ROCHESTER CHIROPRACTIC SPINAL REHABILITATION PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 CHILI AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146243035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853345560 | ||||||||
| FaxNumber: | 5853345581 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 RED CREEK DR STE 120 | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146234273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5845334556 | ||||||||
| FaxNumber: | 5853345581 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 06/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | CARLINO | ||||||||
| AuthorizedOfficialFirstName: | ANTONINO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5853345560 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC DIBE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | X010845 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor |
No ID Information.