Provider Demographics
NPI:1649241209
Name:DEMOCKO, JOSEPH W (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:W
Last Name:DEMOCKO
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 1:1802 E ASH ST
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-4045
Mailing Address - Country:US
Mailing Address - Phone:919-735-2205
Mailing Address - Fax:919-735-2045
Practice Address - Street 1:1802 E ASH ST
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-4045
Practice Address - Country:US
Practice Address - Phone:919-735-2205
Practice Address - Fax:919-735-2045
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2077111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890833AMedicaid
NCU29710Medicare UPIN
NC2448710AMedicare ID - Type Unspecified