Provider Demographics
NPI:1164794889
Name:PICCILLO, DANIEL JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JOSEPH
Last Name:PICCILLO
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 1:901 N PENN ST
Mailing Address - Street 2:F904
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3132
Mailing Address - Country:US
Mailing Address - Phone:570-417-1509
Mailing Address - Fax:
Practice Address - Street 1:2401 E TIOGA ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4625
Practice Address - Country:US
Practice Address - Phone:267-519-9547
Practice Address - Fax:267-519-9567
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-27
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC010552111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor