Provider Demographics
NPI:1841315942
Name:LORICCO, VINCENT P (DC)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:P
Last Name:LORICCO
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 1:675 TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3101
Mailing Address - Country:US
Mailing Address - Phone:203-410-4145
Mailing Address - Fax:203-874-5287
Practice Address - Street 1:183 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-2026
Practice Address - Country:US
Practice Address - Phone:203-933-2225
Practice Address - Fax:203-874-5287
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT798CT111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU12268Medicare UPIN