Provider Demographics
NPI:1093898132
Name:CICH, CURTIS L (DC)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:L
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 1:13563 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-4409
Mailing Address - Country:US
Mailing Address - Phone:763-420-2226
Mailing Address - Fax:763-420-5804
Practice Address - Street 1:13563 GROVE DR
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55311-4409
Practice Address - Country:US
Practice Address - Phone:763-420-2226
Practice Address - Fax:763-420-5804
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2369111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC03115Medicare ID - Type UnspecifiedPROVIDER NUMBER