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General NPI Number Information
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NPI Number | 1821585357
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Entity Type | Individual
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Provider Name | KEVIN THOMAS PERCUOCO DC
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Gender | Male
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 17330 BEAR VALLEY RD STE 105
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City | VICTORVILLE
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State | CA
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Zip | 92395-7741
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Country | US
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Telephone | 760-245-8182
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Fax | 760-245-2123
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Provider Business Mailing Address
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Address Line | 3200 INGERSOLL AVE STE E
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City | DES MOINES
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State | IA
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Zip | 50312-3917
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Country | US
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Telephone | 515-620-3550
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Fax | 515-259-6383
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 33702
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 081984
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License Number State | IA
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