Provider Demographics
NPI:1265559678
Name:CICHOCKI, KEVIN E (CHIROPRACTIC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:E
Last Name:CICHOCKI
Suffix:
Gender:M
Credentials:CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 CENTER RD STE 206
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1945
Mailing Address - Country:US
Mailing Address - Phone:716-259-1700
Mailing Address - Fax:
Practice Address - Street 1:290 CENTER RD STE 206
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1945
Practice Address - Country:US
Practice Address - Phone:716-259-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX00R588-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT25946Medicare UPIN
NYDD2435Medicare PIN