Provider Demographics
NPI:1568681732
Name:VESCIO, MATTHEW J (DC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:VESCIO
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 1:310 E CHESTNUT ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-3660
Mailing Address - Country:US
Mailing Address - Phone:315-337-1883
Mailing Address - Fax:315-337-1874
Practice Address - Street 1:310 E CHESTNUT ST
Practice Address - Street 2:SUITE1
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-3660
Practice Address - Country:US
Practice Address - Phone:315-337-1883
Practice Address - Fax:315-337-1874
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010622111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD5651Medicare ID - Type Unspecified