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General NPI Number Information
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NPI Number | 1871764100
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Entity Type | Organization
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Legal Business Name | PERRY J CICCHINI DC PA
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 805 S BLACK HORSE PIKE
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City | BLACKWOOD
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State | NJ
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Zip | 08012
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Country | US
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Telephone | 856-228-8888
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Fax | 856-228-9323
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Provider Business Mailing Address
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Address Line | 805 S BLACK HORSE PIKE
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City | BLACKWOOD
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State | NJ
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Zip | 08012
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Country | US
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Telephone | 856-228-8888
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Fax | 856-228-9323
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Authorized Official
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Title or Position | PROPRIETOR
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Name | PERRY J CICCHINI
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Credential | DC PA
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Telephone | 856-228-8888
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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 | 38MC00338700
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License Number State | NJ
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