MEDICARE: DR. PATRICIA ELLEN DEJOY D.C.

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	X009168	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P020009168	OTHER	NY	BLUE CROSS/BLUE SHIELD
2	7949244	OTHER	NY	AETNA
3	P010119168	OTHER	NY	BLUE CHOICE
4	C09168-8W	OTHER	NY	WORKER'S COMP

General Provider Information

NPI Number	:	1619944865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA ELLEN DEJOY D.C.

Provider Business Mailing Address
First Line	:	95 ALLENS CREEK RD
Second Line	:	BLDG 1 SUITE 313
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3250
Country	:	US
Telephone Number	:	585-286-9188
Fax Number	:

Provider Business Practice Location Address
First Line	:	95 ALLENS CREEK RD
Second Line	:	BLDG 1 SUITE 313
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3250
Country	:	US
Telephone Number	:	585-286-9188
Fax Number	:

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	02/19/2013

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