Provider Demographics
NPI:1215068218
Name:DICELLO CHIROPRACTIC CARE, P. C.
Entity type:Organization
Organization Name:DICELLO CHIROPRACTIC CARE, P. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DICELLO
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:570-622-1170
Mailing Address - Street 1:1825 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2001
Mailing Address - Country:US
Mailing Address - Phone:570-622-1170
Mailing Address - Fax:
Practice Address - Street 1:1825 W MARKET ST
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2001
Practice Address - Country:US
Practice Address - Phone:570-622-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC006181-L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP4384000OtherOXFORD ID NUMBER
PA2187051OtherAETNA ID NUMBER
PA008742OtherINDEPENDANCE BLUE SHIELD
PA4242090001OtherMEDICARE DME PROVIDER NO
PAP4384000OtherOXFORD ID NUMBER
PA4242090001OtherMEDICARE DME PROVIDER NO