Provider Demographics
NPI:1033285879
Name:CICH, FREDERICK WILLIAM (DC)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:WILLIAM
Last Name:CICH
Suffix:
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 1:768 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHRUB OAK
Mailing Address - State:NY
Mailing Address - Zip Code:10588
Mailing Address - Country:US
Mailing Address - Phone:914-245-6924
Mailing Address - Fax:
Practice Address - Street 1:691 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535
Practice Address - Country:US
Practice Address - Phone:914-245-6924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2938111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX37661Medicare UPIN