Provider Demographics
NPI:1982892089
Name:CHIROPRACTIC ASSOCIATES OF WESTERLY INC
Entity Type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF WESTERLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SICILIANO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:401-596-4394
Mailing Address - Street 1:110 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-1864
Mailing Address - Country:US
Mailing Address - Phone:401-596-4394
Mailing Address - Fax:
Practice Address - Street 1:110 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-1864
Practice Address - Country:US
Practice Address - Phone:401-596-4394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9020-7OtherRHODE ISLAND BCBS
RI359009020Medicare PIN