Provider Demographics
NPI:1932116811
Name:FICO, NEIL S (DC)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:S
Last Name:FICO
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 1:12465 OCEAN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PAWLEYS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29585-7133
Mailing Address - Country:US
Mailing Address - Phone:843-235-3426
Mailing Address - Fax:843-235-3427
Practice Address - Street 1:12465 OCEAN HIGHWAY
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-7133
Practice Address - Country:US
Practice Address - Phone:843-235-3426
Practice Address - Fax:843-235-3427
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2157111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U651720281Medicare ID - Type Unspecified
562143258Medicare UPIN