Healthcare Provider Details

I. General information

NPI: 1467408575
Provider Name (Legal Business Name): GREGORY T. YACUCCI D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W. BASIN ROAD PENN MART SHOPPING CENTER
NEW CASTLE DE
19720-5060
US

IV. Provider business mailing address

105 W. BASIN ROAD PENN MART SHOPPING CENTER
NEW CASTLE DE
19720-5060
US

V. Phone/Fax

Practice location:
  • Phone: 302-328-1444
  • Fax:
Mailing address:
  • Phone: 302-328-1444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberFL0000438
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: