Provider Demographics
NPI:1912993767
Name:CHICOINE, JOHN S (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:CHICOINE
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:PO BOX 326
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:SD
Mailing Address - Zip Code:57053-0326
Mailing Address - Country:US
Mailing Address - Phone:605-297-4481
Mailing Address - Fax:605-297-3922
Practice Address - Street 1:380 N. MAIN AVE.
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:SD
Practice Address - Zip Code:57053-0326
Practice Address - Country:US
Practice Address - Phone:605-297-4481
Practice Address - Fax:605-297-3922
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS86199Medicare ID - Type Unspecified