Provider Demographics
NPI:1457568834
Name:DELUCIA, ELENA N (DC)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:N
Last Name:DELUCIA
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 1:497 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4074
Mailing Address - Country:US
Mailing Address - Phone:718-499-7175
Mailing Address - Fax:718-499-5364
Practice Address - Street 1:497 6TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4074
Practice Address - Country:US
Practice Address - Phone:718-499-7175
Practice Address - Fax:718-499-5364
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005068-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX30671Medicare PIN