Provider Demographics
NPI:1720161664
Name:CUCCARO, LOUIS A (DC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:A
Last Name:CUCCARO
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 1:1049 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1334
Mailing Address - Country:US
Mailing Address - Phone:732-571-1177
Mailing Address - Fax:732-571-4958
Practice Address - Street 1:1049 BROADWAY
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1334
Practice Address - Country:US
Practice Address - Phone:732-571-1177
Practice Address - Fax:732-571-4958
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00131000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2041804Medicaid
NJ2041804Medicaid
NJT45499Medicare UPIN