Provider Demographics
NPI:1659494714
Name:MARCUCELLA, NANCY JOSEPHINE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:JOSEPHINE
Last Name:MARCUCELLA
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S TOPANGA CANYON BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:TOPANGA
Mailing Address - State:CA
Mailing Address - Zip Code:90290-3159
Mailing Address - Country:US
Mailing Address - Phone:310-455-2225
Mailing Address - Fax:310-455-0797
Practice Address - Street 1:120 S TOPANGA CANYON BLVD
Practice Address - Street 2:STE 210
Practice Address - City:TOPANGA
Practice Address - State:CA
Practice Address - Zip Code:90290-3159
Practice Address - Country:US
Practice Address - Phone:310-455-2225
Practice Address - Fax:310-455-0797
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC15790111N00000X
CAAC4908171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC4908OtherACUPUNCTURE LICENSE
CA954279766OtherTAX I.D.
CADC15790Medicare ID - Type Unspecified