MEDICARE: DR. RENEE BOCCIO DC

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
1	111N00000X	Chiropractor	X010111	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C10111-5W	OTHER	NY	WORKERS COMPENSATION

General Provider Information

NPI Number	:	1013121011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE BOCCIO DC

Provider Business Mailing Address
First Line	:	2090 OLD HICKORY TREE RD STE 107
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-8901
Country	:	US
Telephone Number	:	407-593-1273
Fax Number	:	352-353-4717

Provider Business Practice Location Address
First Line	:	2090 OLD HICKORY TREE RD STE 107
Second Line	:
City	:	SAINT CLOUD
State	:	FL
Zip	:	34772-8901
Country	:	US
Telephone Number	:	407-593-1273
Fax Number	:	352-353-4717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	10/08/2024

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