Provider Demographics
NPI:1861899973
Name:PEAK CHIROPRACTIC OF ROCHESTER
Entity type:Organization
Organization Name:PEAK CHIROPRACTIC OF ROCHESTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PENKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-444-7325
Mailing Address - Street 1:1655 ELMWOOD AVE
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-3429
Mailing Address - Country:US
Mailing Address - Phone:585-444-7325
Mailing Address - Fax:585-991-6656
Practice Address - Street 1:1655 ELMWOOD AVE
Practice Address - Street 2:SUITE 235
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-3429
Practice Address - Country:US
Practice Address - Phone:585-444-7325
Practice Address - Fax:585-991-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012367111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1063852390OtherNPI
NY1437558129OtherNPI