Provider Demographics
NPI:1568527091
Name:CIPOLLA, JOSEPH R (DC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:CIPOLLA
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 1:2200 SAINT PAUL ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-1026
Mailing Address - Country:US
Mailing Address - Phone:585-520-0345
Mailing Address - Fax:585-342-9484
Practice Address - Street 1:2200 SAINT PAUL ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-1026
Practice Address - Country:US
Practice Address - Phone:585-520-0345
Practice Address - Fax:585-342-9484
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7412359OtherAETNA
NY109891ANOtherPREFERRED CARE
NYC10218-81OtherWORKERS COMP.
NY010218OtherNO FAULT
NY010218OtherNO FAULT
NY687435Medicare UPIN