Provider Demographics
NPI:1194797332
Name:TUCCI, MICHAEL ELI (DC)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ELI
Last Name:TUCCI
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 1:28125 BRADLEY RD
Mailing Address - Street 2:SUITE 240A
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2248
Mailing Address - Country:US
Mailing Address - Phone:951-672-4801
Mailing Address - Fax:951-672-4802
Practice Address - Street 1:28125 BRADLEY RD
Practice Address - Street 2:SUITE 240A
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2248
Practice Address - Country:US
Practice Address - Phone:951-672-4801
Practice Address - Fax:951-672-4802
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC16566111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0165660Medicare ID - Type Unspecified
CAP00191557Medicare ID - Type UnspecifiedRAILROAD MEDICARE