Provider Demographics
NPI:1417977281
Name:CALICCHIO, MARC ANTHONY (DC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:ANTHONY
Last Name:CALICCHIO
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 1:2917 WINDMILL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1679
Mailing Address - Country:US
Mailing Address - Phone:610-685-8527
Mailing Address - Fax:
Practice Address - Street 1:2917 WINDMILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SINKING SPRING
Practice Address - State:PA
Practice Address - Zip Code:19608-1679
Practice Address - Country:US
Practice Address - Phone:610-685-8527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC007924L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU82936Medicare UPIN
PACA044027Medicare ID - Type Unspecified