1508027483 NPI number — CICCONE CHIROPRACTIC, INC.

Table of content: (NPI 1508027483)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508027483 NPI number — CICCONE CHIROPRACTIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CICCONE CHIROPRACTIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508027483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 486
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH LANCASTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01561-0486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-368-3330
Provider Business Mailing Address Fax Number:
978-368-3337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
SOUTH LANCASTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-368-3330
Provider Business Practice Location Address Fax Number:
978-368-3337
Provider Enumeration Date:
06/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CICCONE
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
978-368-3330

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  3045 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1064159 . This is a "ASHN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1149717 - HMO . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 11535181 . This is a "CAQH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 37237 . This is a "GIC - COMM SERVICE CENTER (UNICARE)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2414216 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7908740 - PPO . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0007435 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1600851 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 415253 . This is a "TUFTS PPO - TUFTS MEDICARE PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y43099 . This is a "ADVENTIST RISK" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: AA50991 . This is a "HARVARD PILGRIM-HEALTH PLAN INC- FSF" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1003835356 . This is a "NPI 1" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9411420 . This is a "PCHS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 95855601 . This is a "NETWORK HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2612009 . This is a "UNITED HEALTH (ACN)" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 5675433 . This is a "COVENTRY" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: Y40169 . This is a "BLUECROSSBLUESHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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