Provider Demographics
NPI:1699076299
Name:CICHOSZ, SCOTT JOSEPH (DC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:JOSEPH
Last Name:CICHOSZ
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 1:1438 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2835
Mailing Address - Country:US
Mailing Address - Phone:608-519-2519
Mailing Address - Fax:608-519-2520
Practice Address - Street 1:1438 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-2835
Practice Address - Country:US
Practice Address - Phone:608-519-2519
Practice Address - Fax:608-519-2520
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007354111N00000X
IL038.011803111N00000X
WI468012111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB2345002Medicare PIN