Provider Demographics
NPI:1528134970
Name:CICERO, GERARD JOSEPH (DC)
Entity type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOSEPH
Last Name:CICERO
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 1:5636 W FULLERTON AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-2352
Mailing Address - Country:US
Mailing Address - Phone:773-237-8660
Mailing Address - Fax:773-237-3159
Practice Address - Street 1:5636 W FULLERTON AVE STE B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60639-2352
Practice Address - Country:US
Practice Address - Phone:773-237-8660
Practice Address - Fax:773-237-3159
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX003537-1111N00000X
IL038004975111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL350052261OtherMEDICARE R.R.
IL1618615OtherBCBS
IL619433OtherU.H.C.
IL0593824OtherAENTA
IL789740Medicare ID - Type Unspecified
ILT38178Medicare UPIN