MEDICARE: PAUL R. PICCIONE D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	DC26121	CA

General Provider Information

NPI Number	:	1083613137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL R. PICCIONE D.C.

Provider Business Mailing Address
First Line	:	959 WOODSIDE RD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3644
Country	:	US
Telephone Number	:	650-367-1948
Fax Number	:	650-367-9356

Provider Business Practice Location Address
First Line	:	959 WOODSIDE RD
Second Line	:
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3644
Country	:	US
Telephone Number	:	650-367-1948
Fax Number	:	650-367-9356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	04/01/2014

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