=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528430733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROCHESTER CHIROPRACTIC PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2015
-----------------------------------------------------
Last Update Date | 02/17/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1687 ENGLISH RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14616-1692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-227-7721
-----------------------------------------------------
Fax | 585-227-7858
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1687 ENGLISH RD
-----------------------------------------------------
City | ROCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14616-1692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 585-227-7721
-----------------------------------------------------
Fax | 585-227-7858
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIROPRACTOR
-----------------------------------------------------
Name | MR. WILLIAM L DESANDIS
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 585-227-7721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | X008556-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------