Provider Demographics
NPI:1447585021
Name:PANUCCI, JON (DC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:PANUCCI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 CLINTON ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-6110
Mailing Address - Country:US
Mailing Address - Phone:518-330-2744
Mailing Address - Fax:
Practice Address - Street 1:15 INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1608
Practice Address - Country:US
Practice Address - Phone:610-644-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010285111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor