Provider Demographics
NPI:1871764100
Name:PERRY J CICCHINI DC PA
Entity type:Organization
Organization Name:PERRY J CICCHINI DC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CICCHINI
Authorized Official - Suffix:
Authorized Official - Credentials:DC PA
Authorized Official - Phone:856-228-8888
Mailing Address - Street 1:805 S BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:BLACKWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08012
Mailing Address - Country:US
Mailing Address - Phone:856-228-8888
Mailing Address - Fax:856-228-9323
Practice Address - Street 1:805 S BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:BLACKWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08012
Practice Address - Country:US
Practice Address - Phone:856-228-8888
Practice Address - Fax:856-228-9323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00338700111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1578804Medicaid
NJ1578804Medicaid