Provider Demographics
NPI:1568738508
Name:PANCARO, ERIC G (DC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:G
Last Name:PANCARO
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 1:471 CORTLANDT ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-3330
Mailing Address - Country:US
Mailing Address - Phone:973-759-2222
Mailing Address - Fax:973-759-2226
Practice Address - Street 1:471 CORTLANDT ST
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:07109-3330
Practice Address - Country:US
Practice Address - Phone:973-759-2222
Practice Address - Fax:973-759-2226
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor