Provider Demographics
NPI:1861802530
Name:MASUCCI, MICHAEL LAURENS (DC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LAURENS
Last Name:MASUCCI
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 1:110 PALOMINO DR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8009
Mailing Address - Country:US
Mailing Address - Phone:314-630-8991
Mailing Address - Fax:
Practice Address - Street 1:1701 MILITARY TRL STE 145B
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-6330
Practice Address - Country:US
Practice Address - Phone:561-781-0989
Practice Address - Fax:561-781-0947
Is Sole Proprietor?:No
Enumeration Date:2014-05-05
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014013287111N00000X
FLCH12555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2014013287OtherMISSOURI LICENSURE
FLCH12555OtherFLORIDA LICENSURE