Provider Demographics
NPI:1093311078
Name:VILLECCO, BRENDA EVELYN (DC)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:EVELYN
Last Name:VILLECCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BACON ST UNIT 209
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4494
Mailing Address - Country:US
Mailing Address - Phone:856-669-4951
Mailing Address - Fax:
Practice Address - Street 1:600 BLAIR PARK RD STE 260
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7548
Practice Address - Country:US
Practice Address - Phone:802-857-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006.0134150111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor