Provider Demographics
NPI:1881658516
Name:MICUCCI, MARC L (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:MICUCCI
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 1:2589 WASHINGTON RD STE 410
Mailing Address - Street 2:
Mailing Address - City:UPPER ST CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2566
Mailing Address - Country:US
Mailing Address - Phone:412-833-1101
Mailing Address - Fax:412-833-1075
Practice Address - Street 1:2589 WASHINGTON RD STE 410
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-2566
Practice Address - Country:US
Practice Address - Phone:412-833-1101
Practice Address - Fax:412-833-1075
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009131111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013693110001Medicaid
PAV00240Medicare UPIN
PA1013693110001Medicaid