Provider Demographics
NPI:1750306130
Name:SHORES, COLBY (DC)
Entity type:Individual
Prefix:
First Name:COLBY
Middle Name:
Last Name:SHORES
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 1:190 PERRIN DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2412
Mailing Address - Country:US
Mailing Address - Phone:585-544-1540
Mailing Address - Fax:585-544-1580
Practice Address - Street 1:1738 RIDGE RD E
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:585-544-1540
Practice Address - Fax:585-544-1580
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009968111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU83209Medicare UPIN
NYCC3892Medicare ID - Type Unspecified