Provider Demographics
NPI:1295811024
Name:BISACCIA, JOHN JAMES (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JAMES
Last Name:BISACCIA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:802 INDUSTRIAL AVE
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495
Mailing Address - Country:US
Mailing Address - Phone:802-863-2272
Mailing Address - Fax:802-658-0823
Practice Address - Street 1:802 INDUSTRIAL AVE
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495
Practice Address - Country:US
Practice Address - Phone:802-863-2272
Practice Address - Fax:802-658-0823
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT006000986111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015151Medicaid
VT29174OtherBCBS
VTP00089364OtherMEDICARE RAILROAD PIN#
VTP00089364OtherMEDICARE RAILROAD PIN#