Provider Demographics
NPI:1962956961
Name:ASCIOTI, SAMUEL WALLACE (DC)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:WALLACE
Last Name:ASCIOTI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ALLENS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3228
Mailing Address - Country:US
Mailing Address - Phone:585-442-3220
Mailing Address - Fax:585-442-1017
Practice Address - Street 1:30 ALLENS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618
Practice Address - Country:US
Practice Address - Phone:585-442-3220
Practice Address - Fax:585-442-1017
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012862111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1578625927OtherBLUE CROSS BLUE SHIELD
NY1578625927OtherEMPIRE
NY1578625927OtherRMSCO
NY1578625927OtherAETNA
NY1578625927OtherPOMCO
NY1578625927OtherEMBLEM
NY1578625927OtherFIDELIS
NYX012862-1OtherNYS WORKER'S COMPENSATION
NY1578625927OtherUNITED HEALTHCARE
NY1578625927OtherTODAY'S OPTION
NY1578625927OtherLANDMARK
NY1578625927OtherELMCO