Provider Demographics
NPI:1912905084
Name:SICURELLA, JOSEPH (DC)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:SICURELLA
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 1:600 N US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-3072
Mailing Address - Country:US
Mailing Address - Phone:772-978-9916
Mailing Address - Fax:772-978-9918
Practice Address - Street 1:600 N US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-3072
Practice Address - Country:US
Practice Address - Phone:772-978-9916
Practice Address - Fax:772-978-9918
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2009-11-17
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
FLCH7769111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor