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General NPI Number Information
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NPI Number | 1801447933
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Entity Type | Organization
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Legal Business Name | ROCHESTER SPORTS CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 09/20/2019
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 10 ASSEMBLY DR STE 105
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City | MENDON
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State | NY
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Zip | 14506-9604
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Country | US
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Telephone | 585-497-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 53 ASSEMBLY DR UNIT 137
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City | MENDON
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State | NY
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Zip | 14506-7006
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Country | US
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Telephone | 585-497-7078
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | KEVEN E. HAGEN
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Credential | DC
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Telephone | 585-497-7078
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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 |
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License Number State |
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