Healthcare Provider Details

I. General information

NPI: 1881651982
Provider Name (Legal Business Name): HOLLY ANNE RUOCCO DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 MAIN STREET G2
SALEM NH
03079
US

IV. Provider business mailing address

202 MAIN STREET G2
SALEM NH
03079
US

V. Phone/Fax

Practice location:
  • Phone: 603-894-5654
  • Fax: 603-894-5681
Mailing address:
  • Phone: 603-894-5654
  • Fax: 603-894-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2150495
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: