Provider Demographics
NPI:1780882043
Name:CICALA, RICHARD ANTHONY (DC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:ANTHONY
Last Name:CICALA
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 1:1000 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1873
Mailing Address - Country:US
Mailing Address - Phone:248-652-7225
Mailing Address - Fax:248-652-7292
Practice Address - Street 1:1000 W UNIVERSITY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-1873
Practice Address - Country:US
Practice Address - Phone:248-652-7225
Practice Address - Fax:248-652-7292
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301009314111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI95-0-F3-5689-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN
MI95-0-F3-5689-0OtherBLUE CROSS BLUE SHIELD OF MICHIGAN