DRD Healthsource Chiropractic PLLC

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

X009170 Issued in NY

Legal business name

DRD HEALTHSOURCE CHIROPRACTIC PLLC

Doing business as

HealthSource Chiropractic

Practice address

90 Erie Canal Dr
Suite D
Rochester, NY 14626-4610

Phone

(585) 225-6430

NPI assigned

Feb 11, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Donald R Dudley, DC,CCSPNPI 1033145115

Title

Chiropractor

Phone

(585) 225-6430

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• HealthSource Chiropractic Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Donald R. Dudley, D.C.

  • Sports Physician Chiropractor
  • Rochester, NY
  • NPI 1033145115
  Medicare reassignment Care Compare group NPD Authorized official
• Jennifer L Spitzer, D.C.

  • Chiropractor
  • Rochester, NY
  • NPI 1336684752
  Medicare reassignment Care Compare group NPD
• Matthew Joseph Phillips, DC

  • Chiropractor
  • Wheaton, MD
  • NPI 1679240931

  NY

  Medicare reassignment Care Compare group
• Andrew Collins, DC

  • Chiropractor
  • Rochester, NY
  • NPI 1841027752
  Medicare reassignment NPD
• Timothy John Daly, D.C.

  • Chiropractor
  • Rochester, NY
  • NPI 1215295506
  Medicare reassignment NPD
• Kellie Anne Dattilo

  • Chiropractor
  • Seneca Falls, NY
  • NPI 1285492447
  Medicare reassignment NPD
• Matthew E Kelly, D.C.

  • Chiropractor
  • Rochester, NY
  • NPI 1053656785
  NPD
• Dorothy S Rupley, DC

  • Chiropractor
  • Hamlin, NY
  • NPI 1225163553
  NPD (past)
• Charles Neal Shaw, D.C., M.S.

  • Chiropractor
  • Rochester, NY
  • NPI 1134456924
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1245479435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 ERIE CANAL DR",
            "address_2": "SUITE D",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264610",
            "telephone_number": "585-225-6430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 ERIE CANAL DR",
            "address_2": "SUITE D",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146264610",
            "telephone_number": "585-225-6430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRD HEALTHSOURCE CHIROPRACTIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-02-11",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "DUDLEY",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIROPRACTOR",
        "authorized_official_telephone_number": "585-225-6430",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC,CCSP"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor, Sports Physician",
            "state": "NY",
            "license": "X009170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "106032AN",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHOICE",
            "identifier": "P010009170",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "647276",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7067356",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS BLUE CROSS/BLUE SHIELD",
            "identifier": "P020009170",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKERS COMPENSATION",
            "identifier": "C09170-4",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Michael Dramer, LCSW
• Rebecca Sue Draper, PSYD, LMSW
• Jordyn Nicole Draveck
• Michelle Draxl, NP
• Rebecca Drayer, M.D., M.SC.
• Kristi Lee Drechsler, PA
• Josette T Drees, SLP
• Kelly Alyse Dreimiller, DPT
• Kathryn J Drennan, M.D.
• Lindsey Grace Dressler, MD

• Sports Physician Chiropractor in Rochester, NY
• Providers in Rochester, NY by specialty
• Sports Physician Chiropractor in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.