Provider Demographics
NPI:1265636369
Name:MARK A CARLUCCI DC LLC
Entity Type:Organization
Organization Name:MARK A CARLUCCI DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARLUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:908-464-0111
Mailing Address - Street 1:438 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07922-1168
Mailing Address - Country:US
Mailing Address - Phone:908-464-0111
Mailing Address - Fax:
Practice Address - Street 1:438 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1168
Practice Address - Country:US
Practice Address - Phone:908-464-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MC05383111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty