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General NPI Number Information
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NPI Number | 1083401970
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Entity Type | Individual
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Provider Name | JOSEPH JAMES CUSICK D.C
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Gender | Male
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 17595 S TAMIAMI TRL STE 101B
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City | FORT MYERS
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State | FL
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Zip | 33908-4500
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Country | US
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Telephone | 239-401-6488
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Fax |
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Provider Business Mailing Address
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Address Line | 8471 VILLAGE EDGE CIR APT 3
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City | FORT MYERS
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State | FL
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Zip | 33919-2905
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Country | US
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Telephone | 859-663-0723
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH15436
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License Number State | FL
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