MEDICARE: DR. MARK Z SOCCIO 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	928	VA

General Provider Information

NPI Number	:	1780656827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK Z SOCCIO D.C.

Provider Business Mailing Address
First Line	:	4668 PEMBROKE BLVD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-490-5828
Fax Number	:	757-490-1214

Provider Business Practice Location Address
First Line	:	4668 PEMBROKE BLVD
Second Line	:	SUITE 101
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23455-6423
Country	:	US
Telephone Number	:	757-490-5828
Fax Number	:	757-490-1214

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

Provider Enumeration Date	:	02/03/2006
Last Update Date	:	02/12/2008

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