Provider Demographics
NPI:1942394705
Name:RUOCCO, BRYAN GASPER (DC)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:GASPER
Last Name:RUOCCO
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 1:21690 RIVER OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-3108
Mailing Address - Country:US
Mailing Address - Phone:440-331-4744
Mailing Address - Fax:440-331-4750
Practice Address - Street 1:21690 RIVER OAKS DR
Practice Address - Street 2:
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-3108
Practice Address - Country:US
Practice Address - Phone:440-331-4744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3424111N00000X
FLCH8816111N00000X
OH3913111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
2332349Medicare ID - Type Unspecified