Healthcare Provider Details

I. General information

NPI: 1518947183
Provider Name (Legal Business Name): JOSEPH ANTHONY CICCONE D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 KING ST
CHAPPAQUA NY
10514-3471
US

IV. Provider business mailing address

175 KING ST
CHAPPAQUA NY
10514-3471
US

V. Phone/Fax

Practice location:
  • Phone: 914-238-0041
  • Fax:
Mailing address:
  • Phone: 914-238-0041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX009423-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: