Provider Demographics
NPI:1508822156
Name:CUCCIA, GARY A (DC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:CUCCIA
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:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:NEW ALEXANDRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15670
Mailing Address - Country:US
Mailing Address - Phone:724-668-7772
Mailing Address - Fax:724-668-8732
Practice Address - Street 1:3223 ROUTE 119
Practice Address - Street 2:
Practice Address - City:NEW ALEXANDRIA
Practice Address - State:PA
Practice Address - Zip Code:15670
Practice Address - Country:US
Practice Address - Phone:724-668-7772
Practice Address - Fax:724-668-8732
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005558L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U49655Medicare UPIN
PA769070Medicare ID - Type Unspecified