Provider Demographics
NPI:1013360155
Name:HERRILD, NICOLAS (DC)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:
Last Name:HERRILD
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 1:3110 GILBERT ST
Mailing Address - Street 2:STE B
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-1934
Mailing Address - Country:US
Mailing Address - Phone:715-732-4018
Mailing Address - Fax:715-735-6864
Practice Address - Street 1:3110 GILBERT ST STE A
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-1934
Practice Address - Country:US
Practice Address - Phone:715-732-4018
Practice Address - Fax:715-735-6864
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-13
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2301010587111N00000X
FLCH12058111N00000X
WI5311111N00000X
FL390200000X
WI5311-12111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty