Provider Demographics
NPI:1104031764
Name:DICIAULA HEALTH SERVICES, SC
Entity type:Organization
Organization Name:DICIAULA HEALTH SERVICES, SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICIAULA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:262-695-0022
Mailing Address - Street 1:213 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-3435
Mailing Address - Country:US
Mailing Address - Phone:262-695-0022
Mailing Address - Fax:262-695-0011
Practice Address - Street 1:213 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-3435
Practice Address - Country:US
Practice Address - Phone:262-695-0022
Practice Address - Fax:262-695-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3967-012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty