Provider Demographics
NPI:1013935907
Name:FICOCELLI, LORRAINE (DC)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:FICOCELLI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:
Other - Last Name:FICOCELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:171 CADY CT
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004
Mailing Address - Country:US
Mailing Address - Phone:404-803-2982
Mailing Address - Fax:
Practice Address - Street 1:365 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3845
Practice Address - Country:US
Practice Address - Phone:740-689-1175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002248111N00000X
GA006339111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor