Healthcare Provider Details

I. General information

NPI: 1699726208
Provider Name (Legal Business Name): NORTH COUNTY SPINE AND SPORTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 03/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 70 4867 WEST LAKE ST SUITE 6
DUNKIRK NY
14048-0070
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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number009274
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID R ROOT
Title or Position: OWNER
Credential: DC, PT
Phone: 716-366-2229