Provider Demographics
NPI:1891769048
Name:RS PICCHIOTTI DC PC
Entity Type:Organization
Organization Name:RS PICCHIOTTI DC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:PICCHIOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-441-2225
Mailing Address - Street 1:3430 TOWNE POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-5320
Mailing Address - Country:US
Mailing Address - Phone:563-441-2225
Mailing Address - Fax:563-823-8733
Practice Address - Street 1:3430 TOWNE POINTE DR
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-5320
Practice Address - Country:US
Practice Address - Phone:563-441-2225
Practice Address - Fax:563-823-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA05964111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A00822Medicare UPIN
IA44763Medicare ID - Type Unspecified