Healthcare Provider Details

I. General information

NPI: 1407833247
Provider Name (Legal Business Name): SCOTT STEVEN CICOTTE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13720 N CLEVELAND AVE B
FORT MYERS FL
33903-4300
US

IV. Provider business mailing address

13720 N CLEVELAND AVE B
FORT MYERS FL
33903-4300
US

V. Phone/Fax

Practice location:
  • Phone: 239-997-8100
  • Fax: 239-997-4817
Mailing address:
  • Phone: 239-997-8100
  • Fax: 239-997-4817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH7987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: