Provider Demographics
NPI:1720035868
Name:COCO, JOHN PHILLIP (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PHILLIP
Last Name:COCO
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:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-0552
Mailing Address - Country:US
Mailing Address - Phone:412-523-2759
Mailing Address - Fax:724-327-1334
Practice Address - Street 1:4540 WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-2002
Practice Address - Country:US
Practice Address - Phone:724-327-1333
Practice Address - Fax:724-327-1334
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009326111N00000X
PAAJ009135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA209330YD23Medicare PIN