Provider Demographics
NPI:1124342084
Name:TICHIO, JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:TICHIO
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 N GENESEE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-1848
Mailing Address - Country:US
Mailing Address - Phone:310-743-3843
Mailing Address - Fax:323-430-8116
Practice Address - Street 1:6109 LINDENHURST AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4808
Practice Address - Country:US
Practice Address - Phone:323-430-8116
Practice Address - Fax:323-430-8116
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-22
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 27548111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor