MEDICARE: DR. DAVID JOSEPH SICILIANO DC

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	DCP00201	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4400048	OTHER	RI	UNITED HEALTHCARE
2	050000201RI01	OTHER	CT	ANTHEM BCBS OF CT

General Provider Information

NPI Number	:	1619972064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID JOSEPH SICILIANO DC

Provider Business Mailing Address
First Line	:	110 HIGH ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-1864
Country	:	US
Telephone Number	:	401-596-4394
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 HIGH ST
Second Line	:
City	:	WESTERLY
State	:	RI
Zip	:	02891-1864
Country	:	US
Telephone Number	:	401-596-4394
Fax Number	:

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

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/06/2007

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