Provider Demographics
NPI:1679106066
Name:DEBOLE CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:DEBOLE CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-489-5868
Mailing Address - Street 1:6280 ROUTE 96 STE E
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1408
Mailing Address - Country:US
Mailing Address - Phone:585-433-5680
Mailing Address - Fax:
Practice Address - Street 1:6280 ROUTE 96 STE E
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1408
Practice Address - Country:US
Practice Address - Phone:585-433-5680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-13
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty