Provider Demographics
NPI:1003835356
Name:CICCONE, DENNIS JAMES JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:JAMES
Last Name:CICCONE
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HIGH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01510-2906
Mailing Address - Country:US
Mailing Address - Phone:978-368-3330
Mailing Address - Fax:978-368-3337
Practice Address - Street 1:45 HIGH ST
Practice Address - Street 2:SUITE A
Practice Address - City:CLINTON
Practice Address - State:MA
Practice Address - Zip Code:01510-2906
Practice Address - Country:US
Practice Address - Phone:978-368-3330
Practice Address - Fax:978-368-3337
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY37107OtherBLUE CROSS OF MA
MACI-Y45820Medicare ID - Type UnspecifiedPROVIDER NUMBER
MAY37107OtherBLUE CROSS OF MA