Provider Demographics
NPI:1982734190
Name:DICCIANNI, STEPHEN BLAISE (DC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BLAISE
Last Name:DICCIANNI
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 1:15 W 44TH ST
Mailing Address - Street 2:8TH. FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6611
Mailing Address - Country:US
Mailing Address - Phone:212-944-0707
Mailing Address - Fax:212-840-6375
Practice Address - Street 1:15 W 44TH ST
Practice Address - Street 2:8TH. FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-6611
Practice Address - Country:US
Practice Address - Phone:212-944-0707
Practice Address - Fax:212-840-6375
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX-003415-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC-003415-1OtherNY WORKERS COMP. #
NYP3623491OtherOXFORD I.D. #