# LIVE WELL CHIROPRACTIC OF MASSAPEQUA PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518131911
- **Authorized official:** DR. RENEE BOCCIO DC (PRESIDENT)
- **Authorized official phone:** (516) 316-2032

## Contact information

- **Practice address:** 2466 N JERUSALEM RD, NORTH BELLMORE, NY 11710-1107
- **Practice address phone:** (516) 316-2032
- **Practice address fax:** (352) 353-4717
- **Mailing address:** 2745 RUBY ROSE LN, SAINT CLOUD, FL 34771-9345
- **Mailing address phone:** (516) 316-2032
- **Mailing address fax:** (352) 353-4717

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | X010111 | NY | Yes |

## Other

- **Enumeration date:** 04/16/2008
- **Last updated:** 10/01/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | C101115W | WORKERS COMPENSATION | NY |