Provider Demographics
NPI:1770594772
Name:PRACELLA, JEFFREY JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:PRACELLA
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 1:1525 ROUTE 22
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4039
Mailing Address - Country:US
Mailing Address - Phone:845-278-6601
Mailing Address - Fax:
Practice Address - Street 1:1525 ROUTE 22
Practice Address - Street 2:SUITE 2
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-4039
Practice Address - Country:US
Practice Address - Phone:845-278-6601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004984-1111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT53077Medicare UPIN
NYX28561Medicare ID - Type Unspecified