Provider Demographics
NPI:1093882235
Name:GREATER ROCHESTER FAMILY & SPORTS CHIROPRACTIC OFFICE
Entity Type:Organization
Organization Name:GREATER ROCHESTER FAMILY & SPORTS CHIROPRACTIC OFFICE
Other - Org Name:GREATER ROCHESTER CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MAIORANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP
Authorized Official - Phone:585-442-3220
Mailing Address - Street 1:30 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3228
Mailing Address - Country:US
Mailing Address - Phone:585-442-3220
Mailing Address - Fax:585-442-1017
Practice Address - Street 1:30 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3228
Practice Address - Country:US
Practice Address - Phone:585-442-3220
Practice Address - Fax:585-442-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1178Medicare ID - Type Unspecified