Provider Demographics
NPI:1205173002
Name:PROSSER, NICHOLAS C (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:C
Last Name:PROSSER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6605 PITTSFORD PALMYRA RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-3407
Mailing Address - Country:US
Mailing Address - Phone:585-278-8351
Mailing Address - Fax:585-223-1582
Practice Address - Street 1:6605 PITTSFORD PALMYRA RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-278-8351
Practice Address - Fax:585-223-1582
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110099134AMedicaid