Provider Demographics
NPI:1528419314
Name:DR. BOCCI D.C. LTD.
Entity Type:Organization
Organization Name:DR. BOCCI D.C. LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:BOCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:847-226-6818
Mailing Address - Street 1:4520 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1545
Mailing Address - Country:US
Mailing Address - Phone:847-226-6818
Mailing Address - Fax:
Practice Address - Street 1:19 S. LASALLE ST.
Practice Address - Street 2:#503
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1444
Practice Address - Country:US
Practice Address - Phone:312-236-9355
Practice Address - Fax:312-236-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILV02018Medicare UPIN