Provider Demographics
NPI:1124145537
Name:CICHOCKI, JASON D (CICHOPRACTOR)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:CICHOCKI
Suffix:
Gender:M
Credentials:CICHOPRACTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DICK RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1849
Mailing Address - Country:US
Mailing Address - Phone:716-681-3333
Mailing Address - Fax:716-681-3037
Practice Address - Street 1:345 DICK RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1849
Practice Address - Country:US
Practice Address - Phone:716-681-3333
Practice Address - Fax:716-681-3037
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX009547-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD2436Medicare PIN
NYU78664Medicare UPIN