Provider Demographics
NPI:1679838957
Name:JUSTIN P CALHOUN DC PC
Entity Type:Organization
Organization Name:JUSTIN P CALHOUN DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-924-9540
Mailing Address - Street 1:7171 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8989
Mailing Address - Country:US
Mailing Address - Phone:585-924-9540
Mailing Address - Fax:585-924-4615
Practice Address - Street 1:7171 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8989
Practice Address - Country:US
Practice Address - Phone:585-924-9540
Practice Address - Fax:585-924-4615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC08555-7OtherWORKERS COMPENSATION NUMBER
NYC08555-7OtherWORKERS COMPENSATION NUMBER
NYUP5564Medicare UPIN