Healthcare Provider Details

I. General information

NPI: 1750306130
Provider Name (Legal Business Name): COLBY SHORES D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1738 RIDGE RD E
ROCHESTER NY
14622-2157
US

IV. Provider business mailing address

190 PERRIN DR
ROCHESTER NY
14622-2412
US

V. Phone/Fax

Practice location:
  • Phone: 585-544-1540
  • Fax: 585-544-1580
Mailing address:
  • Phone: 585-544-1540
  • Fax: 585-544-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberX009968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: