MEDICARE: DR. MARC L MICUCCI D.C

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	009131	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881658516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARC L MICUCCI D.C

Provider Business Mailing Address
First Line	:	2589 WASHINGTON RD STE 410
Second Line	:
City	:	UPPER ST CLAIR
State	:	PA
Zip	:	15241-2566
Country	:	US
Telephone Number	:	412-833-1101
Fax Number	:	412-833-1075

Provider Business Practice Location Address
First Line	:	2589 WASHINGTON RD STE 410
Second Line	:
City	:	UPPER ST CLAIR
State	:	PA
Zip	:	15241-2566
Country	:	US
Telephone Number	:	412-833-1101
Fax Number	:	412-833-1075

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

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	01/23/2023

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