Provider Demographics
NPI:1114461563
Name:MASUCCI CORPORATION
Entity Type:Organization
Organization Name:MASUCCI CORPORATION
Other - Org Name:PURE HEALTH CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:H
Authorized Official - Last Name:MASUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-647-7780
Mailing Address - Street 1:8761 US HIGHWAY 42
Mailing Address - Street 2:SUITE C
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9315
Mailing Address - Country:US
Mailing Address - Phone:859-647-7780
Mailing Address - Fax:859-647-7716
Practice Address - Street 1:8761 US HIGHWAY 42
Practice Address - Street 2:SUITE C
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-9315
Practice Address - Country:US
Practice Address - Phone:859-647-7780
Practice Address - Fax:859-647-7716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-05
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4253111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty