Provider Demographics
NPI:1013207455
Name:ANTHONY, NICHOLAS T (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:T
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:ANTHONY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:826 HEALING WATER TRL
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79602-8190
Mailing Address - Country:US
Mailing Address - Phone:325-660-4629
Mailing Address - Fax:
Practice Address - Street 1:1917 INDUSTRIAL BLVD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7833
Practice Address - Country:US
Practice Address - Phone:325-788-2000
Practice Address - Fax:325-788-2020
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11744111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB152056Medicare PIN