MEDICARE: DR. NICHOLAS ANDREW PUCCIO D.C.

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	38MC00650900	NJ

General Provider Information

NPI Number	:	1063598647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ANDREW PUCCIO D.C.

Provider Business Mailing Address
First Line	:	45 HOMESTEAD DR
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1004
Country	:	US
Telephone Number	:	609-324-7778
Fax Number	:	609-324-7742

Provider Business Practice Location Address
First Line	:	45 HOMESTEAD DR
Second Line	:	SUITE A
City	:	COLUMBUS
State	:	NJ
Zip	:	08022-1004
Country	:	US
Telephone Number	:	609-324-7778
Fax Number	:	609-324-7742

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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