Provider Demographics
NPI:1326179326
Name:DICELLO, CHRISTINA MARIE (D C)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARIE
Last Name:DICELLO
Suffix:
Gender:F
Credentials:D C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2001
Mailing Address - Country:US
Mailing Address - Phone:570-622-1170
Mailing Address - Fax:
Practice Address - Street 1:1825 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2001
Practice Address - Country:US
Practice Address - Phone:570-622-1170
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006181-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADI008742OtherINDEPENDANCE BLUE SHIELD
PAP4384000OtherOXFORD ID NUBER
PADC006181-LOtherLICENSE NUMBER
PA2187051OtherAETNA ID NUMBER
PADI837112Medicare ID - Type Unspecified
PADI008742OtherINDEPENDANCE BLUE SHIELD