Healthcare Provider Details

I. General information

NPI: 1386635142
Provider Name (Legal Business Name): JOHN MICHAEL VENTURA D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ENGLISH RD
ROCHESTER NY
14616-1609
US

IV. Provider business mailing address

50 BRIGHTON ST
ROCHESTER NY
14607-2644
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-7720
  • Fax: 585-227-7858
Mailing address:
  • Phone: 585-442-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number3549
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: