Provider Demographics
NPI:1730169525
Name:SOROCHINSKY, NICHOLAI (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAI
Middle Name:
Last Name:SOROCHINSKY
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 1:2132 FIVE MILE LINE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2209
Mailing Address - Country:US
Mailing Address - Phone:315-651-0299
Mailing Address - Fax:585-586-5196
Practice Address - Street 1:2132 FIVE MILE LINE RD
Practice Address - Street 2:SUITE D
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2209
Practice Address - Country:US
Practice Address - Phone:315-651-0299
Practice Address - Fax:585-586-5196
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011167111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA0918Medicare ID - Type Unspecified