Provider Demographics
NPI:1083613137
Name:PICCIONE, PAUL R (DC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:R
Last Name:PICCIONE
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 1:959 WOODSIDE RD
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3644
Mailing Address - Country:US
Mailing Address - Phone:650-367-1948
Mailing Address - Fax:650-367-9356
Practice Address - Street 1:959 WOODSIDE RD
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3644
Practice Address - Country:US
Practice Address - Phone:650-367-1948
Practice Address - Fax:650-367-9356
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26121111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0261210Medicare ID - Type Unspecified
CAU76253Medicare UPIN