Provider Demographics
NPI:1891572160
Name:LARICCIA, MARCELLINE (DC)
Entity Type:Individual
Prefix:DR
First Name:MARCELLINE
Middle Name:
Last Name:LARICCIA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 NEW HAMPSHIRE ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-4070
Mailing Address - Country:US
Mailing Address - Phone:603-997-2227
Mailing Address - Fax:
Practice Address - Street 1:260 WESTERN AVE STE 209
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2457
Practice Address - Country:US
Practice Address - Phone:207-838-5643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECR2949111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor