MEDICARE: MARK ANDREW CARLUCCI DC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	MC05383	NJ
2	111N00000X	Chiropractor	MCO5383	NJ

General Provider Information

NPI Number	:	1356544431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ANDREW CARLUCCI DC

Provider Business Mailing Address
First Line	:	438 SPRINGFIELD AVE
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1168
Country	:	US
Telephone Number	:	908-464-0111
Fax Number	:

Provider Business Practice Location Address
First Line	:	438 SPRINGFIELD AVE
Second Line	:
City	:	BERKELEY HEIGHTS
State	:	NJ
Zip	:	07922-1168
Country	:	US
Telephone Number	:	908-464-0111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	07/08/2007

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Directions to “ MARK ANDREW CARLUCCI DC” Practice Location

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