Provider Demographics
NPI:1598747644
Name:PIRRUCCELLO, PAUL ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:PIRRUCCELLO
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 1:3670 GRANT DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5309
Mailing Address - Country:US
Mailing Address - Phone:775-852-3333
Mailing Address - Fax:775-322-0606
Practice Address - Street 1:3670 GRANT DR
Practice Address - Street 2:SUITE 101
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-5309
Practice Address - Country:US
Practice Address - Phone:775-852-3333
Practice Address - Fax:775-322-0606
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVB282111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV34189Medicare ID - Type Unspecified
NVT67324Medicare UPIN