Provider Demographics
NPI:1710205430
Name:VICTOR ADVANCED CHIROPRACTIC & WELLNESS PC
Entity type:Organization
Organization Name:VICTOR ADVANCED CHIROPRACTIC & WELLNESS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:585-398-1201
Mailing Address - Street 1:311 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1163
Mailing Address - Country:US
Mailing Address - Phone:585-398-1201
Mailing Address - Fax:585-398-1202
Practice Address - Street 1:311 W MAIN ST
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1163
Practice Address - Country:US
Practice Address - Phone:585-398-1201
Practice Address - Fax:585-398-1202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-05
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011074111N00000X
NYX0111201111N00000X
NYX0115811111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty