Healthcare Provider Details

I. General information

NPI: 1528282688
Provider Name (Legal Business Name): JEANNINE CICCHINI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 S BLACK HORSE PIKE
BLACKWOOD NJ
08012-2813
US

IV. Provider business mailing address

136 SHERWIN RD
MULLICA HILL NJ
08062-2427
US

V. Phone/Fax

Practice location:
  • Phone: 856-228-8888
  • Fax: 856-228-9323
Mailing address:
  • Phone: 856-228-8888
  • Fax: 856-228-9323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number38MC00578900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: