Provider Demographics
NPI:1548394521
Name:CUCOLO, MATTHEW JAMES (DC)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:JAMES
Last Name:CUCOLO
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 446
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:CT
Mailing Address - Zip Code:06444-0446
Mailing Address - Country:US
Mailing Address - Phone:203-879-1385
Mailing Address - Fax:203-879-1856
Practice Address - Street 1:250 WOLCOTT RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-2634
Practice Address - Country:US
Practice Address - Phone:203-879-1385
Practice Address - Fax:203-879-1856
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor