Provider Demographics
NPI:1851416259
Name:SIRACUSE, DAVID C (DC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:SIRACUSE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-1822
Mailing Address - Country:US
Mailing Address - Phone:585-256-1770
Mailing Address - Fax:585-271-0438
Practice Address - Street 1:1717 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-1822
Practice Address - Country:US
Practice Address - Phone:585-256-1770
Practice Address - Fax:585-271-0438
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008715111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor