MEDICARE: DR. TINA C SHORES DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	X009575	NY

General Provider Information

NPI Number	:	1588640593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TINA C SHORES DC

Provider Business Mailing Address
First Line	:	180 SENECA RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2041
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1738 EAST RIDGE ROAD
Second Line	:	CHIROPRACTIC ASSOCIATES OF ROCHESTER
City	:	ROCHESTER
State	:	NY
Zip	:	14622
Country	:	US
Telephone Number	:	585-544-1540
Fax Number	:	585-544-1580

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	07/08/2007

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