Provider Demographics
NPI:1619972064
Name:SICILIANO, DAVID JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:SICILIANO
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 1:110 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1864
Mailing Address - Country:US
Mailing Address - Phone:401-596-4394
Mailing Address - Fax:
Practice Address - Street 1:110 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1864
Practice Address - Country:US
Practice Address - Phone:401-596-4394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI4400048OtherUNITED HEALTHCARE
CT050000201RI01OtherANTHEM BCBS OF CT
CT050000201RI01OtherANTHEM BCBS OF CT