Healthcare Provider Details

I. General information

NPI: 1114001245
Provider Name (Legal Business Name): DAVID SAVERIO FICCO DC,NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LAWRENCEVILLE SUWANEE RD SUITE 130
LAWRENCEVILLE GA
30043-1408
US

IV. Provider business mailing address

1860 ATKINSON RD SUITE 107-107
LAWRENCEVILLE GA
30043-5065
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-0073
  • Fax: 770-497-1773
Mailing address:
  • Phone: 770-497-0073
  • Fax: 770-497-1773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number2796
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: