Provider Demographics
NPI:1588745160
Name:LAROCCA, MICHAEL THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:THOMAS
Last Name:LAROCCA
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 1:2288 DREW ST STE A
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3307
Mailing Address - Country:US
Mailing Address - Phone:727-797-7090
Mailing Address - Fax:727-799-5327
Practice Address - Street 1:2288 DREW ST STE A
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3307
Practice Address - Country:US
Practice Address - Phone:727-797-7090
Practice Address - Fax:727-799-5327
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2563111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH0002563OtherWORKERS COMP
FL88108Medicare ID - Type Unspecified
FLT85817Medicare UPIN