Provider Demographics
NPI:1033248489
Name:PASSERO, JAMES JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:PASSERO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:JOSEPH
Other - Last Name:PASSERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:8899 SHADY SHORES RD
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NY
Mailing Address - Zip Code:13624-3262
Mailing Address - Country:US
Mailing Address - Phone:585-202-7596
Mailing Address - Fax:315-782-0978
Practice Address - Street 1:8899 SHADY SHORES RD
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NY
Practice Address - Zip Code:13624-3261
Practice Address - Country:US
Practice Address - Phone:585-202-7596
Practice Address - Fax:315-408-2874
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYXO10366-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU93417Medicare UPIN
NYDD3981Medicare ID - Type Unspecified