Provider Demographics
NPI:1427685569
Name:PERCUOCO CHIROPRACTIC AND REHABILITATION, PLLC
Entity type:Organization
Organization Name:PERCUOCO CHIROPRACTIC AND REHABILITATION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:PERCUOCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:515-620-3550
Mailing Address - Street 1:8601 WESTOWN PKWY UNIT 5106
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1653
Mailing Address - Country:US
Mailing Address - Phone:563-370-0776
Mailing Address - Fax:
Practice Address - Street 1:3200 INGERSOLL AVE STE E
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50312-3917
Practice Address - Country:US
Practice Address - Phone:515-620-3550
Practice Address - Fax:515-259-6383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821585357Medicaid