Provider Demographics
NPI:1578603536
Name:GIOVANNUCCI, LUCIANO (DC)
Entity Type:Individual
Prefix:DR
First Name:LUCIANO
Middle Name:
Last Name:GIOVANNUCCI
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 1:880 MARSHALL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALLEGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49010-1690
Mailing Address - Country:US
Mailing Address - Phone:269-673-6106
Mailing Address - Fax:269-673-1828
Practice Address - Street 1:880 MARSHALL ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALLEGAN
Practice Address - State:MI
Practice Address - Zip Code:49010-1690
Practice Address - Country:US
Practice Address - Phone:269-673-6106
Practice Address - Fax:269-673-1828
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301007903111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU85268Medicare UPIN
MION30680Medicare ID - Type Unspecified