Provider Demographics
NPI:1952570913
Name:LOUIS PANUCCIO PA
Entity Type:Organization
Organization Name:LOUIS PANUCCIO PA
Other - Org Name:A1A CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PANUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-575-2225
Mailing Address - Street 1:PO BOX 2837
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33468
Mailing Address - Country:US
Mailing Address - Phone:561-575-2225
Mailing Address - Fax:561-746-7405
Practice Address - Street 1:275 TONEY PENNA DR
Practice Address - Street 2:SUITE #12
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-5752
Practice Address - Country:US
Practice Address - Phone:561-575-2225
Practice Address - Fax:561-746-7405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH0006894111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK5112Medicare PIN