Healthcare Provider Details

I. General information

NPI: 1588660302
Provider Name (Legal Business Name): DAVID R ROOT D.C., P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4867 W LAKE RD SUITE 6
DUNKIRK NY
14048-9613
US

IV. Provider business mailing address

4867 W LAKE RD SUITE 6
DUNKIRK NY
14048-9613
US

V. Phone/Fax

Practice location:
  • Phone: 716-366-2229
  • Fax: 716-366-7874
Mailing address:
  • Phone: 716-366-2229
  • Fax: 716-366-7874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4983811
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5002477
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: