Provider Demographics
NPI:1215990940
Name:MICUCCI, DEANA (DC)
Entity type:Individual
Prefix:DR
First Name:DEANA
Middle Name:
Last Name:MICUCCI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 WASHINGTON RD
Mailing Address - Street 2:SUITE 620
Mailing Address - City:UPPER ST CLAIR
Mailing Address - State:PA
Mailing Address - Zip Code:15241-2574
Mailing Address - Country:US
Mailing Address - Phone:412-833-1101
Mailing Address - Fax:412-833-1075
Practice Address - Street 1:2555 WASHINGTON RD
Practice Address - Street 2:SUITE 620
Practice Address - City:UPPER ST CLAIR
Practice Address - State:PA
Practice Address - Zip Code:15241-2574
Practice Address - Country:US
Practice Address - Phone:412-833-1101
Practice Address - Fax:412-833-1075
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA009132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013694290001Medicaid
PA087723Medicare PIN
PA1013694290001Medicaid