Provider Demographics
NPI:1821585357
Name:PERCUOCO, KEVIN THOMAS (DC)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:PERCUOCO
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 1:3200 INGERSOLL AVE STE E
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312-3917
Mailing Address - Country:US
Mailing Address - Phone:515-620-3550
Mailing Address - Fax:515-259-6383
Practice Address - Street 1:17330 BEAR VALLEY RD STE 105
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7741
Practice Address - Country:US
Practice Address - Phone:760-245-8182
Practice Address - Fax:760-245-2123
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33702111N00000X
IA081984111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111N00000XChiropractic ProvidersChiropractor