Provider Demographics
NPI:1568047835
Name:USCOLA, MARC
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:USCOLA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N SEWARD MERIDIAN PKWY
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-6682
Mailing Address - Country:US
Mailing Address - Phone:907-357-7463
Mailing Address - Fax:
Practice Address - Street 1:1701 N SEWARD MERIDIAN PKWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6682
Practice Address - Country:US
Practice Address - Phone:907-357-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK167303111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor