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General NPI Number Information
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NPI Number | 1073824082
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Entity Type | Organization
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Legal Business Name | ROCHESTER SPINE & SPORTS CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 06/24/2010
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Last Update Date | 12/30/2020
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Provider Practice Location Address
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Address Line | 135 SULLYS TRL STE 5
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City | PITTSFORD
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State | NY
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Zip | 14534-4564
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Country | US
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Telephone | 585-678-1362
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Fax | 585-348-9102
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Provider Business Mailing Address
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Address Line | 135 SULLYS TRL STE 5
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City | PITTSFORD
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State | NY
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Zip | 14534-4564
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Country | US
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Telephone | 585-678-1362
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Fax | 585-348-9102
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. MATTHEW J BUFFAN
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Credential | D.C.
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Telephone | 585-678-1362
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 011867
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License Number State | NY
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