Provider Demographics
NPI:1518131911
Name:LIVE WELL CHIROPRACTIC OF MASSAPEQUA PC
Entity Type:Organization
Organization Name:LIVE WELL CHIROPRACTIC OF MASSAPEQUA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:516-316-2032
Mailing Address - Street 1:17 LUMBER RD STE 8
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2188
Mailing Address - Country:US
Mailing Address - Phone:516-316-2032
Mailing Address - Fax:
Practice Address - Street 1:17 LUMBER RD STE 8
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-2188
Practice Address - Country:US
Practice Address - Phone:516-316-2032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010111111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC101115WOtherWORKERS COMPENSATION
NYC101115WOtherWORKERS COMPENSATION