Provider Demographics
NPI:1114265006
Name:PACILIO CHIROPRACTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:PACILIO CHIROPRACTIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PACILIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:856-939-6196
Mailing Address - Street 1:515 N BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:RUNNEMEDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08078-1320
Mailing Address - Country:US
Mailing Address - Phone:856-939-6196
Mailing Address - Fax:
Practice Address - Street 1:515 N BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:RUNNEMEDE
Practice Address - State:NJ
Practice Address - Zip Code:08078-1320
Practice Address - Country:US
Practice Address - Phone:856-939-6196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00579400111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0696713000OtherAMERIHEALTH PIN
NJ072288OtherMEDICARE PTAN
NJ2271828000OtherAMERIHEALTH GROUP
NJP3118812OtherOXFORD
NJ3480975OtherAETNA
NJP00058776OtherRAILROAD
NJP00058776OtherRAILROAD
NJ3480975OtherAETNA