Provider Demographics
NPI:1255408613
Name:MORICI, ANTONIO PHILLIP (DC)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:PHILLIP
Last Name:MORICI
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 1:43200 DEQUINDRE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1707
Mailing Address - Country:US
Mailing Address - Phone:586-997-2441
Mailing Address - Fax:586-997-2506
Practice Address - Street 1:43200 DEQUINDRE RD
Practice Address - Street 2:STE 150
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-997-2441
Practice Address - Fax:248-619-9703
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIAM006126111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
950F354060OtherBLUE CROSS
0E05268Medicare ID - Type Unspecified