Provider Demographics
NPI:1588660302
Name:ROOT, DAVID R (DC, PT)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ROOT
Suffix:
Gender:M
Credentials:DC, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4867 W LAKE RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-9613
Mailing Address - Country:US
Mailing Address - Phone:716-366-2229
Mailing Address - Fax:716-366-7874
Practice Address - Street 1:4867 W LAKE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-9613
Practice Address - Country:US
Practice Address - Phone:716-366-2229
Practice Address - Fax:716-366-7874
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4983811225100000X
NY5002477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0599Medicare PIN
NYRB0598Medicare PIN