Healthcare Provider Details

I. General information

NPI: 1851661714
Provider Name (Legal Business Name): GERARD CICERO DC FACO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 01/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 W FULLERTON AVE
CHICAGO IL
60639-2307
US

IV. Provider business mailing address

5700 W FULLERTON AVE
CHICAGO IL
60639-2307
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 TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: CATHY G JUNGHEIM
Title or Position: OFFICE MANAGER
Credential:
Phone: 773-237-8660