Provider Demographics
NPI:1104189976
Name:ROCHESTER CHIROPRACTIC SPINAL REHABILITATION PLLC
Entity Type:Organization
Organization Name:ROCHESTER CHIROPRACTIC SPINAL REHABILITATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTONINO
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DC DIBE
Authorized Official - Phone:585-334-5560
Mailing Address - Street 1:1160 CHILI AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-3035
Mailing Address - Country:US
Mailing Address - Phone:585-334-5560
Mailing Address - Fax:585-334-5581
Practice Address - Street 1:400 RED CREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4273
Practice Address - Country:US
Practice Address - Phone:584-533-4556
Practice Address - Fax:585-334-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU99215Medicare UPIN