Provider Demographics
NPI:1992832299
Name:SILECCHIO, PETER M (DC)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:SILECCHIO
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 1:4519 ALAMO ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93063-1734
Mailing Address - Country:US
Mailing Address - Phone:805-584-1634
Mailing Address - Fax:805-526-8200
Practice Address - Street 1:4519 ALAMO ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93063-1734
Practice Address - Country:US
Practice Address - Phone:805-584-1634
Practice Address - Fax:805-526-8200
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24610111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC24610Medicare ID - Type Unspecified