Provider Demographics
NPI:1447344999
Name:LAROCCO, DAVID RAYMOND (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:RAYMOND
Last Name:LAROCCO
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 1:701 MUNRO AVE
Mailing Address - Street 2:P O BOX 436
Mailing Address - City:MAMARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-3424
Mailing Address - Country:US
Mailing Address - Phone:914-381-3237
Mailing Address - Fax:914-381-3238
Practice Address - Street 1:701 MUNRO AVE
Practice Address - Street 2:
Practice Address - City:MAMARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543-3424
Practice Address - Country:US
Practice Address - Phone:914-381-3237
Practice Address - Fax:914-381-3238
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX06B21Medicare PIN