Provider Demographics
NPI:1528065620
Name:CICHONSKI, PETER JOHN (DC)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:CICHONSKI
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 1:6876 MAGNOLIA AVE
Mailing Address - Street 2:STE C
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2861
Mailing Address - Country:US
Mailing Address - Phone:951-788-0163
Mailing Address - Fax:951-788-0149
Practice Address - Street 1:6876 MAGNOLIA AVE
Practice Address - Street 2:STE C
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2861
Practice Address - Country:US
Practice Address - Phone:951-788-0163
Practice Address - Fax:951-788-0149
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22628111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor