Provider Demographics
NPI:1033124573
Name:PRIESTMAN, MICHAEL B (DC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:B
Last Name:PRIESTMAN
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 1:11 NORTH STREET, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424
Mailing Address - Country:US
Mailing Address - Phone:585-396-3180
Mailing Address - Fax:585-296-1152
Practice Address - Street 1:11 NORTH STREET, SUITE 300
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424
Practice Address - Country:US
Practice Address - Phone:585-396-3180
Practice Address - Fax:585-296-1152
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008043111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA9670Medicare PIN
U59329Medicare UPIN