Healthcare Provider Details

I. General information

NPI: 1518131911
Provider Name (Legal Business Name): LIVE WELL CHIROPRACTIC OF MASSAPEQUA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2008
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2466 N JERUSALEM RD
NORTH BELLMORE NY
11710-1107
US

IV. Provider business mailing address

2745 RUBY ROSE LN
SAINT CLOUD FL
34771-9345
US

V. Phone/Fax

Practice location:
  • Phone: 516-316-2032
  • Fax: 352-353-4717
Mailing address:
  • Phone: 516-316-2032
  • Fax: 352-353-4717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX010111
License Number StateNY

VIII. Authorized Official

Name: DR. RENEE BOCCIO
Title or Position: PRESIDENT
Credential: DC
Phone: 516-316-2032