1427685569 NPI number — PERCUOCO CHIROPRACTIC AND REHABILITATION, PLLC

Table of content: (NPI 1427685569)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427685569 NPI number — PERCUOCO CHIROPRACTIC AND REHABILITATION, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERCUOCO CHIROPRACTIC AND REHABILITATION, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427685569
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8601 WESTOWN PKWY UNIT 5106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50266-1653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-370-0776
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3200 INGERSOLL AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DES MOINES
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50312-3917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-620-3550
Provider Business Practice Location Address Fax Number:
515-259-6383
Provider Enumeration Date:
03/26/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PERCUOCO
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER/OPERATOR
Authorized Official Telephone Number:
515-620-3550

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1821585357 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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