Provider Demographics
NPI:1043612781
Name:BALSECA, JOSE (DC)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:BALSECA
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 1:115 SULLYS TRL
Mailing Address - Street 2:STE 13
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 SULLYS TRL
Practice Address - Street 2:STE 13
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4571
Practice Address - Country:US
Practice Address - Phone:585-727-1911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-25
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012597111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor