Provider Demographics
NPI:1164564902
Name:PERCUOCO, PETER PAUL (DC, DACNB)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:PAUL
Last Name:PERCUOCO
Suffix:
Gender:M
Credentials:DC, DACNB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MAIN ST
Mailing Address - Street 2:P.O. BOX 181
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2108
Mailing Address - Country:US
Mailing Address - Phone:978-568-8077
Mailing Address - Fax:978-562-3349
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2108
Practice Address - Country:US
Practice Address - Phone:978-568-8077
Practice Address - Fax:978-562-3349
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1497111NN0400X
CT001597111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY36030OtherBLUE CROSS BLUE SHIELD MA
MAY36030Medicare ID - Type Unspecified
MAY36030OtherBLUE CROSS BLUE SHIELD MA