Provider Demographics
NPI:1013041433
Name:ZICAFOOSE, MARCIA RAE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:RAE
Last Name:ZICAFOOSE
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 DEHESA RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1629
Mailing Address - Country:US
Mailing Address - Phone:619-445-8075
Mailing Address - Fax:
Practice Address - Street 1:255 N ASH ST
Practice Address - Street 2:SUITE 106
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-3068
Practice Address - Country:US
Practice Address - Phone:760-737-8662
Practice Address - Fax:760-737-9865
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14533111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor