Provider Demographics
NPI:1669445193
Name:CASTELLUCCI, RONALD ROBERT (DC)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:ROBERT
Last Name:CASTELLUCCI
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 1:3754 BREVARD RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:HORSE SHOE
Mailing Address - State:NC
Mailing Address - Zip Code:28742-8752
Mailing Address - Country:US
Mailing Address - Phone:828-890-8181
Mailing Address - Fax:
Practice Address - Street 1:3754 BREVARD RD
Practice Address - Street 2:SUITE 114
Practice Address - City:HORSE SHOE
Practice Address - State:NC
Practice Address - Zip Code:28742-8752
Practice Address - Country:US
Practice Address - Phone:828-890-8181
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2368111N00000X
SC2224111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0827HOtherBLUE CROSS BLUE SHIELD
NC0827HOtherBLUE CROSS BLUE SHIELD
U02214Medicare UPIN