Provider Demographics
NPI:1558573451
Name:MARCASE, KENNETH (DC)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:MARCASE
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 1:228 GIBSON DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037
Mailing Address - Country:US
Mailing Address - Phone:412-751-8083
Mailing Address - Fax:
Practice Address - Street 1:1769 PINE HOLLOW RD
Practice Address - Street 2:100
Practice Address - City:MCKEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136
Practice Address - Country:US
Practice Address - Phone:412-771-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005809-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU57013Medicare UPIN
PA789893Medicare ID - Type Unspecified