Provider Demographics
NPI:1265647283
Name:PERCUOCO CHIROPRACTIC NEUROLOGY CENTER, PC
Entity Type:Organization
Organization Name:PERCUOCO CHIROPRACTIC NEUROLOGY CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PERCUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC,CCST,DACNB
Authorized Official - Phone:978-568-8077
Mailing Address - Street 1:213 MAIN ST
Mailing Address - Street 2:SUITE #5
Mailing Address - City:HUDSON
Mailing Address - State:MA
Mailing Address - Zip Code:01749-2300
Mailing Address - Country:US
Mailing Address - Phone:978-568-8077
Mailing Address - Fax:978-562-3349
Practice Address - Street 1:213 MAIN ST
Practice Address - Street 2:SUITE #5
Practice Address - City:HUDSON
Practice Address - State:MA
Practice Address - Zip Code:01749-2300
Practice Address - Country:US
Practice Address - Phone:978-568-8077
Practice Address - Fax:978-562-3349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1497111NN0400X
CT001597111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT9554Medicare UPIN
MAY36030Medicare ID - Type Unspecified