Healthcare Provider Details

I. General information

NPI: 1982935094
Provider Name (Legal Business Name): JAMES M PICCOLINO DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 BRICKELL BAY DR APT 1406
MIAMI FL
33131-2931
US

IV. Provider business mailing address

999 BRICKELL BAY DR APT 1406
MIAMI FL
33131-2931
US

V. Phone/Fax

Practice location:
  • Phone: 855-375-2637
  • Fax: 305-441-8146
Mailing address:
  • Phone: 718-753-8947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberCH9864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: