Provider Demographics
NPI:1003924655
Name:ROCCHIO, GREG WILLIAM (DC, MS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:WILLIAM
Last Name:ROCCHIO
Suffix:
Gender:M
Credentials:DC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25 CHERRY ST
Mailing Address - Street 2:P.O. BOX 485
Mailing Address - City:NAUGATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06770-4109
Mailing Address - Country:US
Mailing Address - Phone:203-723-7401
Mailing Address - Fax:203-723-9167
Practice Address - Street 1:25 CHERRY ST
Practice Address - Street 2:
Practice Address - City:NAUGATUCK
Practice Address - State:CT
Practice Address - Zip Code:06770-4109
Practice Address - Country:US
Practice Address - Phone:203-723-7401
Practice Address - Fax:203-723-9167
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001457111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor