Provider Demographics
NPI:1093870800
Name:SICILIA
Entity Type:Organization
Organization Name:SICILIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JEROME
Authorized Official - Last Name:SICILIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC CCSP
Authorized Official - Phone:509-489-2883
Mailing Address - Street 1:611 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2956
Mailing Address - Country:US
Mailing Address - Phone:509-489-2883
Mailing Address - Fax:509-487-0898
Practice Address - Street 1:611 W GARLAND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-2956
Practice Address - Country:US
Practice Address - Phone:509-489-2883
Practice Address - Fax:509-487-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACH00003110111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB38596Medicare ID - Type Unspecified