Provider Demographics
NPI:1467519363
Name:CICCHINI, PERRY J (DC)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:J
Last Name:CICCHINI
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 1:805 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-2813
Mailing Address - Country:US
Mailing Address - Phone:856-228-8888
Mailing Address - Fax:856-228-9323
Practice Address - Street 1:805 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012-2813
Practice Address - Country:US
Practice Address - Phone:856-228-8888
Practice Address - Fax:856-228-9323
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03387111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ567903Medicare PIN