Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 3549 | NY |
NPI | 1386635142 |
---|---|
Provider Name | John Michael Ventura |
First Address | Rochester, NY 14607-2644 |
Second Address | Rochester, NY 14616-1609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T26209 | (02) | NY |