MEDICARE: DR. TIMOTHY JOHN DALY D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	012173	NY

General Provider Information

NPI Number	:	1215295506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY JOHN DALY D.C.

Provider Business Mailing Address
First Line	:	1851 STONE RD STE 100
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14615-2415
Country	:	US
Telephone Number	:	585-225-6430
Fax Number	:	585-225-9636

Provider Business Practice Location Address
First Line	:	2364 LYELL AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14606-5738
Country	:	US
Telephone Number	:	585-429-5100
Fax Number	:	585-429-5101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2012
Last Update Date	:	11/15/2017

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