Provider Demographics
NPI:1073506044
Name:BOCCI, GARY E (DC)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:E
Last Name:BOCCI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WATERMAN BLVD
Mailing Address - Street 2:260
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-2987
Mailing Address - Country:US
Mailing Address - Phone:707-427-1222
Mailing Address - Fax:707-427-0663
Practice Address - Street 1:2801 WATERMAN BLVD
Practice Address - Street 2:260
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-2987
Practice Address - Country:US
Practice Address - Phone:707-427-1222
Practice Address - Fax:707-427-0663
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 15694111N00000X
CAAC 9268171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0156940Medicare PIN