Provider Demographics
NPI:1205901188
Name:PICARELLO, DAVID ANTHONY (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:PICARELLO
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 1:3646 E RAY RD
Mailing Address - Street 2:STE. 10
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7116
Mailing Address - Country:US
Mailing Address - Phone:480-706-0056
Mailing Address - Fax:
Practice Address - Street 1:3646 E RAY RD
Practice Address - Street 2:STE. 10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7116
Practice Address - Country:US
Practice Address - Phone:480-706-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4945111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0246400OtherBCBS
AZAZ0246400OtherBCBS