Provider Demographics
NPI:1023288115
Name:DOMINIC A. RICCIO, D.C.
Entity type:Organization
Organization Name:DOMINIC A. RICCIO, D.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:RICCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:732-531-3636
Mailing Address - Street 1:1915 HIGHWAY 35
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07755-2714
Mailing Address - Country:US
Mailing Address - Phone:732-531-3636
Mailing Address - Fax:732-531-2999
Practice Address - Street 1:1915 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2714
Practice Address - Country:US
Practice Address - Phone:732-531-3636
Practice Address - Fax:732-531-2999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00357800111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty