Provider Demographics
NPI:1245305085
Name:PICINICH, DAVID A (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:PICINICH
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 1:454 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820
Mailing Address - Country:US
Mailing Address - Phone:607-433-2225
Mailing Address - Fax:607-433-0117
Practice Address - Street 1:454 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820
Practice Address - Country:US
Practice Address - Phone:607-433-2225
Practice Address - Fax:607-433-0117
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX0059761111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10035135OtherCDPHP
NYNY05976OtherMVP
NY10035135OtherCDPHP
T87964Medicare UPIN