Provider Demographics
NPI:1790834398
Name:TRI COUNTY CHIROPRACTIC PC
Entity Type:Organization
Organization Name:TRI COUNTY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:COON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-425-9820
Mailing Address - Street 1:7700 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-9590
Mailing Address - Country:US
Mailing Address - Phone:585-425-9820
Mailing Address - Fax:585-425-8003
Practice Address - Street 1:7700 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-9590
Practice Address - Country:US
Practice Address - Phone:585-425-9820
Practice Address - Fax:585-425-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007792111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1792Medicare UPIN
NYCC1597Medicare ID - Type Unspecified