Provider Demographics
NPI:1033575626
Name:FAIRPORT CHIROPRACTIC
Entity type:Organization
Organization Name:FAIRPORT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-381-7724
Mailing Address - Street 1:1157 FAIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1237
Mailing Address - Country:US
Mailing Address - Phone:585-381-7724
Mailing Address - Fax:585-381-3346
Practice Address - Street 1:1157 FAIRPORT RD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-1237
Practice Address - Country:US
Practice Address - Phone:585-381-7724
Practice Address - Fax:585-381-3346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX3976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty