Provider Demographics
NPI:1760542492
Name:BISBOCCI, BRADY M (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:M
Last Name:BISBOCCI
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 1:46141 NATIONAL RD W
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-8715
Mailing Address - Country:US
Mailing Address - Phone:740-695-5566
Mailing Address - Fax:740-695-9578
Practice Address - Street 1:46141 NATIONAL RD W
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-8715
Practice Address - Country:US
Practice Address - Phone:740-695-5566
Practice Address - Fax:740-695-9578
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2757111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0882811Medicare ID - Type Unspecified
OH5981870001Medicare NSC