Provider Demographics
NPI:1174069629
Name:SACCO CHIROPRACTIC PC
Entity type:Organization
Organization Name:SACCO CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:SACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:570-497-4150
Mailing Address - Street 1:1730 E BROAD ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-5657
Mailing Address - Country:US
Mailing Address - Phone:570-497-4150
Mailing Address - Fax:570-497-4151
Practice Address - Street 1:1730 E BROAD ST STE 1
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-5657
Practice Address - Country:US
Practice Address - Phone:570-497-4150
Practice Address - Fax:570-497-4151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010871111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty