Healthcare Provider Details

I. General information

NPI: 1639624919
Provider Name (Legal Business Name): MICHAEL PICCIRILLO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2390 NE 186TH ST
MIAMI FL
33180-2907
US

IV. Provider business mailing address

1600 S FEDERAL HWY STE 451
POMPANO BEACH FL
33062-7525
US

V. Phone/Fax

Practice location:
  • Phone: 305-932-2202
  • Fax: 754-206-1958
Mailing address:
  • Phone: 754-205-6865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberCH11903
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: