Provider Demographics
NPI:1205192127
Name:PICCOLINO, DAVID (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:PICCOLINO
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 1:18308 NW 68TH AVE
Mailing Address - Street 2:APT E
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3416
Mailing Address - Country:US
Mailing Address - Phone:718-753-9309
Mailing Address - Fax:
Practice Address - Street 1:18308 NW 68TH AVE
Practice Address - Street 2:APT E
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3416
Practice Address - Country:US
Practice Address - Phone:718-753-9309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10593111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor