Provider Demographics
NPI:1841376688
Name:BISACCIA CHIROPRACTORS PC
Entity type:Organization
Organization Name:BISACCIA CHIROPRACTORS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BISACCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:802-863-2272
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:05495-0669
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:05495-7122
Practice Address - Country:US
Practice Address - Phone:802-863-2272
Practice Address - Fax:802-658-0823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1015150Medicaid
VT1015150Medicaid