Provider Demographics
NPI:1588640593
Name:SHORES, TINA C (DC)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:C
Last Name:SHORES
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:M
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:180 SENECA RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1738 EAST RIDGE ROAD
Practice Address - Street 2:CHIROPRACTIC ASSOCIATES OF ROCHESTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622
Practice Address - Country:US
Practice Address - Phone:585-544-1540
Practice Address - Fax:585-544-1580
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU79319Medicare UPIN
NYBB9607Medicare ID - Type UnspecifiedPROV ID