Provider Demographics
NPI:1063598647
Name:PUCCIO, NICHOLAS ANDREW (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:PUCCIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 HOMESTEAD DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:NJ
Mailing Address - Zip Code:08022-1004
Mailing Address - Country:US
Mailing Address - Phone:609-324-7778
Mailing Address - Fax:609-324-7742
Practice Address - Street 1:45 HOMESTEAD DR
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:NJ
Practice Address - Zip Code:08022-1004
Practice Address - Country:US
Practice Address - Phone:609-324-7778
Practice Address - Fax:609-324-7742
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00650900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor