Provider Demographics
NPI:1922372028
Name:ROCHESTER CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:ROCHESTER CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:YASELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-266-2782
Mailing Address - Street 1:1732 E RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2157
Mailing Address - Country:US
Mailing Address - Phone:585-266-2782
Mailing Address - Fax:585-266-2785
Practice Address - Street 1:1732 E RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2157
Practice Address - Country:US
Practice Address - Phone:585-266-2782
Practice Address - Fax:585-266-2785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10954111N00000X
NY10869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152836ANOtherPREFERRED CAREMVP
NYC108698WOtherWORKERSCOMPENSATION2NDPROVIDER
NYP010010954OtherBLUE CROSS/BLUE SHIELD
NYP010010954OtherBLUE CROSSBLUE SHIELD
7697600OtherAETNA
NY7475597OtherAETNASECOND PROVIDER
NYC109548WOtherWORKERS COMPENSATION
NY145441ANOtherPREFERRED CARESECONDPROVIDER
NYP010010869OtherBLUECROSSBLUE SHIELD SECOND PROVIDER
NYC108698WOtherWORKERSCOMPENSATION2NDPROVIDER
NYC109548WOtherWORKERS COMPENSATION
NYBA0313Medicare PIN