Provider Demographics
NPI:1144326323
Name:CICCO, NICHOLAS J (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:CICCO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6805 BERGENLINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:GUTTENBERG
Mailing Address - State:NJ
Mailing Address - Zip Code:07093
Mailing Address - Country:US
Mailing Address - Phone:201-869-6886
Mailing Address - Fax:201-869-4602
Practice Address - Street 1:6805 BERGENLINE AVENUE
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093
Practice Address - Country:US
Practice Address - Phone:201-869-6886
Practice Address - Fax:201-869-4602
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJ01092111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ645284OtherUNITED HEALTH CARE
NJ1032501OtherASHN
NJP762622OtherOXFORD HEALTH
NJ10653570OtherCIGNA HEALTHCARE
NJX5352OtherWELL CHOICE INC
NJ661893OtherACN GROUP
NJ0104288000OtherAMERI HEALTH
NJ33834OtherGHI
NJ0542229OtherAETNA HEALTH
NJP762622OtherOXFORD HEALTH
NJ452894Medicare ID - Type Unspecified