Provider Demographics
NPI:1841596053
Name:PICO, DAVID H (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:PICO
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 1:250 PASCACK RD
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642
Mailing Address - Country:US
Mailing Address - Phone:201-263-1882
Mailing Address - Fax:
Practice Address - Street 1:162 W 56 ST #302
Practice Address - Street 2:
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10019
Practice Address - Country:US
Practice Address - Phone:212-765-1333
Practice Address - Fax:212-765-1199
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2011-02-04
Deactivation Date:2011-01-31
Deactivation Code:
Reactivation Date:2011-02-04
Provider Licenses
StateLicense IDTaxonomies
NYX007730111N00000X
NJ4433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
0839192OtherAETNA
P650451OtherOXFORD
X10541OtherEMPIRE
P650451OtherOXFORD
U57556Medicare UPIN