Provider Demographics
NPI:1952632168
Name:DIROCCO, HEATHER (DC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:DIROCCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 AYER AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-4503
Mailing Address - Country:US
Mailing Address - Phone:978-505-0395
Mailing Address - Fax:
Practice Address - Street 1:1215 MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-4707
Practice Address - Country:US
Practice Address - Phone:978-455-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3275111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor