Provider Demographics
NPI:1750362273
Name:RUOCCO, BRYAN T (DC)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:T
Last Name:RUOCCO
Suffix:
Gender:
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2339
Mailing Address - Country:US
Mailing Address - Phone:781-631-3333
Mailing Address - Fax:781-631-3339
Practice Address - Street 1:111 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-2339
Practice Address - Country:US
Practice Address - Phone:781-631-3333
Practice Address - Fax:781-631-3339
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3020111N00000X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor