Provider Demographics
NPI:1083401970
Name:CUSICK, JOSEPH JAMES (DC)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JAMES
Last Name:CUSICK
Suffix:
Gender:
Credentials:DC
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:JAMES
Other - Last Name:CUSICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:8471 VILLAGE EDGE CIR APT 3
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-2905
Mailing Address - Country:US
Mailing Address - Phone:859-663-0723
Mailing Address - Fax:
Practice Address - Street 1:17595 S TAMIAMI TRL STE 101B
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4500
Practice Address - Country:US
Practice Address - Phone:239-401-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-23
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH15436111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor