Provider Demographics
NPI:1891816054
Name:PUCCIO CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:PUCCIO CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:609-324-7778
Mailing Address - Street 1:45 HOMESTEAD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1004
Mailing Address - Country:US
Mailing Address - Phone:609-324-7778
Mailing Address - Fax:609-324-7742
Practice Address - Street 1:45 HOMESTEAD DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1004
Practice Address - Country:US
Practice Address - Phone:609-324-7778
Practice Address - Fax:609-324-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00650900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty