Provider Demographics
NPI:1639624919
Name:PICCIRILLO, MICHAEL (DC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PICCIRILLO
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 1:1600 S FEDERAL HWY STE 451
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-7525
Mailing Address - Country:US
Mailing Address - Phone:754-205-6865
Mailing Address - Fax:
Practice Address - Street 1:2390 NE 186TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2907
Practice Address - Country:US
Practice Address - Phone:305-932-2202
Practice Address - Fax:754-206-1958
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-17
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH11903111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician