Provider Demographics
NPI:1710960513
Name:CHICOINE, BRADLEY A (DC)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:A
Last Name:CHICOINE
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 1:1501 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1204
Mailing Address - Country:US
Mailing Address - Phone:712-252-0633
Mailing Address - Fax:712-252-3904
Practice Address - Street 1:1501 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1204
Practice Address - Country:US
Practice Address - Phone:712-252-0633
Practice Address - Fax:712-252-3904
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA04520111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0157800Medicaid
IA29618OtherWELLMARK BCBS
IA15780Medicare ID - Type Unspecified
IA0157800Medicaid