Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 38MC00350200 | NJ |
NPI | 1194829507 |
---|---|
Provider Name | Dr. John Francis Carlucci |
First Address | Jackson, NJ 08527 |
Second Address | Jackson, NJ 08527-2301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T88762 | (02) | NJ |