Provider Demographics
NPI:1508027483
Name:CICCONE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:CICCONE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CICCONE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:978-368-3330
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:SOUTH LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01561-0486
Mailing Address - Country:US
Mailing Address - Phone:978-368-3330
Mailing Address - Fax:978-368-3337
Practice Address - Street 1:131 MAIN STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTH LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01561
Practice Address - Country:US
Practice Address - Phone:978-368-3330
Practice Address - Fax:978-368-3337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1064159OtherASHN
MA1149717 - HMOOtherAETNA
MA11535181OtherCAQH
MA37237OtherGIC - COMM SERVICE CENTER (UNICARE)
MA2414216OtherCIGNA
MA7908740 - PPOOtherAETNA
MA0007435OtherMEDICARE PTAN
MA1600851OtherMASS HEALTH
MA415253OtherTUFTS PPO - TUFTS MEDICARE PREFERRED
MAY43099OtherADVENTIST RISK
MAAA50991OtherHARVARD PILGRIM-HEALTH PLAN INC- FSF
1003835356OtherNPI 1
MA9411420OtherPCHS
MA95855601OtherNETWORK HEALTH
MA2612009OtherUNITED HEALTH (ACN)
MA5675433OtherCOVENTRY
MAY40169OtherBLUECROSSBLUESHIELD
MAY43099OtherADVENTIST RISK
MA7908740 - PPOOtherAETNA