Provider Demographics
NPI:1932261344
Name:CIANCIULLI, DENNIS MICHAEL JR (DC)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:MICHAEL
Last Name:CIANCIULLI
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3730 N JOSEY LN
Mailing Address - Street 2:STE 122
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-2439
Mailing Address - Country:US
Mailing Address - Phone:281-367-8101
Mailing Address - Fax:281-367-8209
Practice Address - Street 1:3730 N JOSEY LN STE 122
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2439
Practice Address - Country:US
Practice Address - Phone:972-492-5670
Practice Address - Fax:729-492-5679
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
00683UOtherPTIN
TX6976OtherSTATE LICENSE
TX364481469OtherTAX ID
TX8F3390OtherBLUE CROSS BLUE SHIELD