MEDICARE: PUCCIO CHIROPRACTIC LLC

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	:	1891816054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUCCIO CHIROPRACTIC LLC

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	:	OWNER
Name	:	DR. NICHOLAS ANDREW PUCCIO
Credential	:	DC
Telephone Number	:	609-324-7778

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	08/22/2020

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