Provider Demographics
NPI:1528430733
Name:ROCHESTER CHIROPRACTIC PC
Entity type:Organization
Organization Name:ROCHESTER CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:DESANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-227-7721
Mailing Address - Street 1:1687 ENGLISH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14616-1692
Mailing Address - Country:US
Mailing Address - Phone:585-227-7721
Mailing Address - Fax:585-227-7858
Practice Address - Street 1:1687 ENGLISH RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14616-1692
Practice Address - Country:US
Practice Address - Phone:585-227-7721
Practice Address - Fax:585-227-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-27
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008556-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14261BOtherMEDICARE PROV ID