MEDICARE: DR. JOSEPH CICCARELLO DC

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	111N00000X	Chiropractor	CH2023	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477521631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH CICCARELLO DC

Provider Business Mailing Address
First Line	:	1011 S US HIGHWAY 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4903
Country	:	US
Telephone Number	:	813-621-2180
Fax Number	:	813-626-2225

Provider Business Practice Location Address
First Line	:	1011 S US HIGHWAY 301
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33619-4903
Country	:	US
Telephone Number	:	813-621-2180
Fax Number	:	813-626-2225

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	12/21/2011

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