Provider Demographics
NPI:1356890651
Name:CARLUCCI, DANA RACHELLE (DC)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:RACHELLE
Last Name:CARLUCCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:RACHELLE
Other - Last Name:MADDEX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:215 NEEDHAM ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1111
Mailing Address - Country:US
Mailing Address - Phone:209-236-0555
Mailing Address - Fax:
Practice Address - Street 1:215 NEEDHAM ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1111
Practice Address - Country:US
Practice Address - Phone:209-236-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-27
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor