Provider Demographics
NPI:1871544296
Name:VANNUCCI, ROCKY (DC)
Entity type:Individual
Prefix:DR
First Name:ROCKY
Middle Name:
Last Name:VANNUCCI
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 1:401 N ROCK ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-2227
Mailing Address - Country:US
Mailing Address - Phone:870-942-4646
Mailing Address - Fax:
Practice Address - Street 1:401 N ROCK ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-2227
Practice Address - Country:US
Practice Address - Phone:870-942-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1042111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4420017OtherUNITED HEALTHCARE
AR350008095OtherRAILROAD MEDICARE
AR5362237OtherAETNA
ARCP43510OtherUNION PACIFIC RAILROAD
AR59926OtherBLUE CROSS BLUE SHIELD
AR110468718Medicaid
AR350008095OtherRAILROAD MEDICARE
AR59926OtherBLUE CROSS BLUE SHIELD