Provider Demographics
NPI:1447383435
Name:ROCKEFELLER, MICHAEL VINCENT (DC,LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:ROCKEFELLER
Suffix:
Gender:M
Credentials:DC,LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2027
Mailing Address - Country:US
Mailing Address - Phone:607-433-2225
Mailing Address - Fax:607-433-0117
Practice Address - Street 1:454 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2027
Practice Address - Country:US
Practice Address - Phone:607-433-2225
Practice Address - Fax:607-433-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003822171100000X
NY11405111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty