Provider Demographics
NPI:1871554980
Name:D&M CHIROPRACTIC AND THERAPEUTIC REHAB INC
Entity type:Organization
Organization Name:D&M CHIROPRACTIC AND THERAPEUTIC REHAB INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:L
Authorized Official - Last Name:MICUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-833-1101
Mailing Address - Street 1:2589 WASHINGTON RD STE 410
Mailing Address - Street 2:
Mailing Address - City:UPPER ST CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2566
Mailing Address - Country:US
Mailing Address - Phone:412-833-1101
Mailing Address - Fax:412-833-1075
Practice Address - Street 1:2589 WASHINGTON RD STE 410
Practice Address - Street 2:
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-2566
Practice Address - Country:US
Practice Address - Phone:412-833-1101
Practice Address - Fax:412-833-1075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009132111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013693110001Medicaid
PA1013693110001Medicaid