MEDICARE: DR. DAVID R ROOT D.C., P.T.

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	225100000X	Physical Therapist	4983811	NY
2	111N00000X	Chiropractor	5002477	NY

General Provider Information

NPI Number	:	1588660302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R ROOT D.C., P.T.

Provider Business Mailing Address
First Line	:	4867 W LAKE RD
Second Line	:	SUITE 6
City	:	DUNKIRK
State	:	NY
Zip	:	14048-9613
Country	:	US
Telephone Number	:	716-366-2229
Fax Number	:	716-366-7874

Provider Business Practice Location Address
First Line	:	4867 W LAKE RD
Second Line	:	SUITE 6
City	:	DUNKIRK
State	:	NY
Zip	:	14048-9613
Country	:	US
Telephone Number	:	716-366-2229
Fax Number	:	716-366-7874

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/24/2017

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