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NPI Code Detail

MEDICARE: DR. BRIAN J NOCELLA D.C.

MEDICARE: DR. BRIAN J NOCELLA D.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor005586MI
2111N00000XChiropractor2698SC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10F35023OTHERMIBCBSMI

General Provider Information

NPI Number : 1043343965
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN J NOCELLA D.C.
Provider Business Mailing Address
First Line : 33708 GRAND RIVER AVE
Second Line :
City : FARMINGTON
State : MI
Zip : 48335-3428
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 33708 GRAND RIVER AVE
Second Line :
City : FARMINGTON
State : MI
Zip : 48335-3428
Country : US
Telephone Number : 248-442-9090
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2007
Last Update Date : 07/08/2007

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