Healthcare Provider Details

I. General information

NPI: 1003835356
Provider Name (Legal Business Name): DENNIS JAMES CICCONE JR. D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 HIGH ST SUITE A
CLINTON MA
01510-2906
US

IV. Provider business mailing address

45 HIGH ST SUITE A
CLINTON MA
01510-2906
US

V. Phone/Fax

Practice location:
  • Phone: 978-368-3330
  • Fax: 978-368-3337
Mailing address:
  • Phone: 978-368-3330
  • Fax: 978-368-3337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3045
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: