Healthcare Provider Details

I. General information

NPI: 1568527091
Provider Name (Legal Business Name): JOSEPH R CIPOLLA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 SAINT PAUL ST
ROCHESTER NY
14621-1026
US

IV. Provider business mailing address

2200 SAINT PAUL ST
ROCHESTER NY
14621-1026
US

V. Phone/Fax

Practice location:
  • Phone: 585-520-0345
  • Fax: 585-342-9484
Mailing address:
  • Phone: 585-520-0345
  • Fax: 585-342-9484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010218
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: