Provider Demographics
NPI:1144379066
Name:DICOLA, ANTHONY M (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:M
Last Name:DICOLA
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 1:2400 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4106
Mailing Address - Country:US
Mailing Address - Phone:302-633-3402
Mailing Address - Fax:302-633-6661
Practice Address - Street 1:2400 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4106
Practice Address - Country:US
Practice Address - Phone:302-633-3402
Practice Address - Fax:302-633-6661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEF10000304111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE733671Medicare ID - Type Unspecified