Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | X003537-1 | NY |
Y | 111NX0800X | Chiropractor Orthopedic Specialist | 038004975 | IL |
NPI | 1528134970 |
---|---|
Provider Name | Dr. Gerard Joseph Cicero |
First Address | Chicago, IL 60639-2307 |
Second Address | Chicago, IL 60639-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 10/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0593824 | AENTA (01) | IL |
1618615 | BCBS (01) | IL |
350052261 | MEDICARE R.R. (01) | IL |
619433 | U.H.C. (01) | IL |
T38178 | (02) | IL |