Provider Demographics
NPI:1699765248
Name:MARCECA, MICHAEL A (DC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:A
Last Name:MARCECA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Mailing Address - Street 1:123 ELLIS RD
Mailing Address - Street 2:STE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1483
Mailing Address - Country:US
Mailing Address - Phone:770-461-7664
Mailing Address - Fax:770-461-1676
Practice Address - Street 1:123 ELLIS RD
Practice Address - Street 2:STE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1483
Practice Address - Country:US
Practice Address - Phone:770-461-7664
Practice Address - Fax:770-461-1676
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
52153978OtherBCBS
T97731Medicare UPIN