MEDICARE: EAST AVENUE CHIROPRACTIC P.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	X0011951	NY

General Provider Information

NPI Number	:	1396015442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST AVENUE CHIROPRACTIC P.C.

Provider Business Mailing Address
First Line	:	1641 EAST AVE STE B
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1616
Country	:	US
Telephone Number	:	585-473-7746
Fax Number	:	585-473-7745

Provider Business Practice Location Address
First Line	:	1641 EAST AVE STE B
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14610-1616
Country	:	US
Telephone Number	:	585-473-7746
Fax Number	:	585-473-7745

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. JOSHUA BENJAMIN RITTENBERG
Credential	:	D.C.
Telephone Number	:	585-473-7746

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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