MEDICARE: DR. ERIC DAVID CHICO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1991	WV
2	207Q00000X	Family Medicine Physician	34.006224	OH

General Provider Information

NPI Number	:	1033257118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC DAVID CHICO D.O.

Provider Business Mailing Address
First Line	:	2632 WOODMAN CENTER CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-1477
Country	:	US
Telephone Number	:	937-739-7100
Fax Number	:	304-235-7041

Provider Business Practice Location Address
First Line	:	2632 WOODMAN CENTER CT
Second Line	:
City	:	KETTERING
State	:	OH
Zip	:	45420-1477
Country	:	US
Telephone Number	:	937-739-7100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/15/2024

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