Provider Demographics
NPI:1477521631
Name:CICCARELLO, JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CICCARELLO
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 1:1011 S US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4903
Mailing Address - Country:US
Mailing Address - Phone:813-621-2180
Mailing Address - Fax:813-626-2225
Practice Address - Street 1:1011 S US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-4903
Practice Address - Country:US
Practice Address - Phone:813-621-2180
Practice Address - Fax:813-626-2225
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH2023111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL050781400Medicaid
T56262Medicare UPIN
FL89564Medicare ID - Type Unspecified