Provider Demographics
NPI:1912188020
Name:CHICO, CHRISTINE ROSE (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:ROSE
Last Name:CHICO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:CHICO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:120 E BONEFISH CIR
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33477-7234
Mailing Address - Country:US
Mailing Address - Phone:561-301-2862
Mailing Address - Fax:
Practice Address - Street 1:120 E BONEFISH CIR
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-7234
Practice Address - Country:US
Practice Address - Phone:561-301-2862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6260207L00000X
FLOA6260208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology