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General NPI Number Information
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NPI Number | 1356390678
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Entity Type | Individual
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Provider Name | PAUL EDWARD DOUGHERTY D.C.
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Gender | Male
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Dates
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Enumeration Date | 05/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 435 E HENRIETTA RD CONSULTATIVE SERVICES
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City | ROCHESTER
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State | NY
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Zip | 14620-4629
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Country | US
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Telephone | 585-760-6270
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Fax | 585-760-6295
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Provider Business Mailing Address
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Address Line | 435 E HENRIETTA RD CONSULTATIVE SERVICES
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City | ROCHESTER
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State | NY
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Zip | 14620-4629
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Country | US
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Telephone | 585-760-6270
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Fax | 585-760-6295
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NX0800X
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Taxonomy Name | Orthopedic Chiropractor
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License Number | X006538-1
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License Number State | NY
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