Healthcare Provider Details

I. General information

NPI: 1508027483
Provider Name (Legal Business Name): CICCONE CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN STREET SUITE 7
SOUTH LANCASTER MA
01561
US

IV. Provider business mailing address

PO BOX 486
SOUTH LANCASTER MA
01561-0486
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: DR. DENNIS JAMES CICCONE JR.
Title or Position: OWNER/DOCTOR
Credential: D.C.
Phone: 978-368-3330