=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366767253
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SCOTT J. ROCCHIO, D.C., LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2010
-----------------------------------------------------
Last Update Date | 04/02/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 SANDPIPER CRESCENT
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-996-1364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13 SANDPIPER CRESCENT
-----------------------------------------------------
City | MILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-996-1364
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | D.C./OWNER
-----------------------------------------------------
Name | DR. SCOTT J. ROCCHIO
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 20399621364
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 001792
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------