Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 3045 | MA |
NPI | 1003835356 |
---|---|
Provider Name | Dr. Dennis James Ciccone JR. |
First Address | Clinton, MA 01510-2906 |
Second Address | Clinton, MA 01510-2906 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V07902 | (02) | MA |
Y37107 | BLUE CROSS OF MA (01) | MA |