Provider Demographics
NPI:1831392307
Name:CICERO CHIROPRACTIC INC.
Entity type:Organization
Organization Name:CICERO CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-984-3578
Mailing Address - Street 1:209 S PERU ST
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9687
Mailing Address - Country:US
Mailing Address - Phone:317-984-3578
Mailing Address - Fax:317-984-3410
Practice Address - Street 1:209 S PERU ST
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9687
Practice Address - Country:US
Practice Address - Phone:317-984-3578
Practice Address - Fax:317-984-3410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001594111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN213570Medicare PIN