Provider Demographics
NPI:1346732401
Name:CHIRICO, DANA (CNIM)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:CHIRICO
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28345 BECK ROAD
Mailing Address - Street 2:STE. 103
Mailing Address - City:WIXOM
Mailing Address - State:MI
Mailing Address - Zip Code:48393
Mailing Address - Country:US
Mailing Address - Phone:813-624-3128
Mailing Address - Fax:
Practice Address - Street 1:28345 BECK ROAD
Practice Address - Street 2:STE. 103
Practice Address - City:WIXOM
Practice Address - State:MI
Practice Address - Zip Code:48393
Practice Address - Country:US
Practice Address - Phone:813-624-3128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
4144OtherABRET CNIM