Healthcare Provider Details

I. General information

NPI: 1528134970
Provider Name (Legal Business Name): GERARD JOSEPH CICERO D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5636 W FULLERTON AVE STE B
CHICAGO IL
60639-2352
US

IV. Provider business mailing address

5636 W FULLERTON AVE STE B
CHICAGO IL
60639-2352
US

V. Phone/Fax

Practice location:
  • Phone: 773-237-8660
  • Fax: 773-237-3159
Mailing address:
  • Phone: 773-237-8660
  • Fax: 773-237-3159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX003537-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License Number038004975
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: