Provider Demographics
NPI:1568574283
Name:PECCERILLO, MELISSA L (DC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:L
Last Name:PECCERILLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1913 ATLANTIC AVE STE 151
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1061
Mailing Address - Country:US
Mailing Address - Phone:732-939-0366
Mailing Address - Fax:
Practice Address - Street 1:1913 ATLANTIC AVE STE 151
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1061
Practice Address - Country:US
Practice Address - Phone:732-939-0366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-07-19
Deactivation Date:2017-08-01
Deactivation Code:
Reactivation Date:2021-02-03
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00584700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor