Healthcare Provider Details

I. General information

NPI: 1275703324
Provider Name (Legal Business Name): PHOENIX MILLS CHIROPRACTIC CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 COULTER RD
CLIFTON SPRINGS NY
14432-1122
US

IV. Provider business mailing address

6 LITTLE DOE RUN
FAIRPORT NY
14450-8930
US

V. Phone/Fax

Practice location:
  • Phone: 315-462-0390
  • Fax: 315-462-7784
Mailing address:
  • Phone: 585-576-0762
  • Fax: 585-425-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberX003148
License Number StateNY

VIII. Authorized Official

Name: DR. MICHAEL JAMES O'CONNOR
Title or Position: OWNER
Credential: DC
Phone: 585-576-0762