Provider Demographics
NPI:1174639108
Name:CALHOUN, JUSTIN PAUL (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:PAUL
Last Name:CALHOUN
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 1:7171 STATE ROUTE 96
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-8989
Mailing Address - Country:US
Mailing Address - Phone:585-924-9540
Mailing Address - Fax:585-924-4615
Practice Address - Street 1:7171 STATE ROUTE 96
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-8989
Practice Address - Country:US
Practice Address - Phone:585-924-9540
Practice Address - Fax:585-924-4615
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX008555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMC08555-7OtherWORKERS COMP. PROVIDER #
NY14263BOtherMEDICARE #
NYP010008555OtherBLUE CROSS / BLUE SHIELD
NMC08555-7OtherWORKERS COMP. PROVIDER #