Healthcare Provider Details

I. General information

NPI: 1053456640
Provider Name (Legal Business Name): SANDRA ANNE FICO D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W COPANS RD SUITE 1010
MARGATE FL
33063-7747
US

IV. Provider business mailing address

5100 W COPANS RD SUITE 1010
MARGATE FL
33063-7747
US

V. Phone/Fax

Practice location:
  • Phone: 954-975-9988
  • Fax: 954-975-9989
Mailing address:
  • Phone: 954-975-9988
  • Fax: 954-975-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH5264
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: