Healthcare Provider Details

I. General information

NPI: 1376185629
Provider Name (Legal Business Name): PHILLIP RICHARD TOKARZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HELENDALE RD STE 185
ROCHESTER NY
14609-3167
US

IV. Provider business mailing address

500 HELENDALE ROAD SUITE #185
ROCHESTER NY
14609
US

V. Phone/Fax

Practice location:
  • Phone: 585-271-6080
  • Fax: 585-271-6816
Mailing address:
  • Phone: 585-271-6080
  • Fax: 585-271-6816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number013294
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: