MEDICARE: JOSEPH CICCARELLO DC PA

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	CH2023	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255603080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH CICCARELLO DC PA

Provider Business Mailing Address
First Line	:	1011 S US HIGHWAY 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4903
Country	:	US
Telephone Number	:	813-621-3180
Fax Number	:	813-626-2225

Provider Business Practice Location Address
First Line	:	1011 S US HIGHWAY 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4903
Country	:	US
Telephone Number	:	813-621-3180
Fax Number	:	813-626-2225

Authorized Official
Title or Position	:	BILLING
Name	:	MRS. ROBIN E HINES
Credential	:
Telephone Number	:	352-796-9636

Provider Enumeration Date	:	02/09/2012
Last Update Date	:	02/09/2012

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