| Doctor Name: | DR. STEPHEN JAMES PETRUCCELLI |
| NPI Number: | 1710045208 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.C. |
| License Number: | X010203 |
| Business Practice Address: | 39 Division Street Sag Harbor, NY - 11963 |
| Business Phone Number: | 6317258209 |
| Business Fax Number: | 6319191592 |
| Mailing Address: | Po Box 2902, SAG HARBOR |
| State: | NY |
| Postal Code: | 119630401 |
| Phone Number: | 6317258209 |
| Fax Number: | 6317258209 |
| NPI Enumeration Date: | 12/05/2006 |
| NPI Last Update Date: | 03/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 111NS0005X |
| License Number: | X010203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Chiropractic Providers |
| Taxonomy Classification: | Chiropractor |
| Taxonomy Specialization: | Sports Physician |
| Taxonomy Definition: | A sports chiropractor is uniquely trained to provide care and treatment of injuries or illness resulting from sports and physical fitness activities. Doctors of Chiropractic with the Diplomate American Chiropractic Board of Sports Physicians (DACBSP) or the Certified Chiropractic Sports Physician (CCSP), sport specialty certifications from the American Chiropractic Board of Sports Physicians, have advanced training in the assessment, management and rehabilitation of sports related injuries. Extremity care, rehabilitation and soft tissue procedures are common skills utilized by these doctors. The specialty training covers a broad spectrum from the pediatric athlete to professional and Olympic athletes, and everything in between, using a variety of techniques and modalities. |