Provider Demographics
NPI:1063413771
Name:BOCCELLA, JOHN SALVATORE (DC)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SALVATORE
Last Name:BOCCELLA
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 1:10931 STRICKLAND RD
Mailing Address - Street 2:SUITE 131
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-2085
Mailing Address - Country:US
Mailing Address - Phone:919-518-1234
Mailing Address - Fax:919-518-0878
Practice Address - Street 1:10931 STRICKLAND RD
Practice Address - Street 2:SUITE 131
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-2085
Practice Address - Country:US
Practice Address - Phone:919-518-1234
Practice Address - Fax:919-518-0878
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2196111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0829COtherBCBSNC
NC890829CMedicaid
NC5754696OtherAETNA
NY350045059OtherRAILROAD MEDICARE
NC5754696OtherAETNA
NCU58789Medicare UPIN