Provider Demographics
NPI:1467408575
Name:YACUCCI, GREGORY T (DC)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:YACUCCI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W. BASIN ROAD
Mailing Address - Street 2:PENN MART SHOPPING CENTER
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-5060
Mailing Address - Country:US
Mailing Address - Phone:302-328-1444
Mailing Address - Fax:
Practice Address - Street 1:105 W. BASIN ROAD
Practice Address - Street 2:PENN MART SHOPPING CENTER
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-5060
Practice Address - Country:US
Practice Address - Phone:302-328-1444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFL0000438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU55841Medicare UPIN
DE490056Medicare ID - Type Unspecified