Provider Demographics
NPI:1568899037
Name:GARY E BOCCI CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:GARY E BOCCI CHIROPRACTIC, INC
Other - Org Name:FAMILY CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:707-427-1222
Mailing Address - Street 1:2801 WATERMAN BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2987
Mailing Address - Country:US
Mailing Address - Phone:707-427-1222
Mailing Address - Fax:707-427-0663
Practice Address - Street 1:2801 WATERMAN BLVD STE 260
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-427-1222
Practice Address - Fax:707-427-0663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15694111N00000X
CADC21701111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0156940Medicare PIN
CADC0217010Medicare PIN