Provider Demographics
NPI:1639405822
Name:CAMPANELLA CHIROPRACTIC & WELLNESS PLLC
Entity Type:Organization
Organization Name:CAMPANELLA CHIROPRACTIC & WELLNESS PLLC
Other - Org Name:CAMPANELLA CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAMPANELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-334-4060
Mailing Address - Street 1:3313 CHILI AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-5300
Mailing Address - Country:US
Mailing Address - Phone:585-889-3280
Mailing Address - Fax:585-889-7759
Practice Address - Street 1:3313 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5300
Practice Address - Country:US
Practice Address - Phone:585-889-3280
Practice Address - Fax:585-889-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009166-1111NI0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0900XChiropractic ProvidersChiropractorInternistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBB3894Medicare PIN
NYU73927Medicare UPIN