Provider Demographics
NPI:1073824082
Name:ROCHESTER SPINE & SPORTS CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:ROCHESTER SPINE & SPORTS CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUFFAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-678-1362
Mailing Address - Street 1:135 SULLYS TRL STE 5
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4564
Mailing Address - Country:US
Mailing Address - Phone:585-678-1362
Mailing Address - Fax:585-348-9102
Practice Address - Street 1:135 SULLYS TRL STE 5
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4564
Practice Address - Country:US
Practice Address - Phone:585-678-1362
Practice Address - Fax:585-348-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-24
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty