Provider Demographics
NPI:1043629074
Name:HEALY, NICHOLAS BENJAMIN (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:BENJAMIN
Last Name:HEALY
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 1:214 S DILLARD ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3523
Mailing Address - Country:US
Mailing Address - Phone:763-229-3537
Mailing Address - Fax:407-287-6007
Practice Address - Street 1:214 S DILLARD ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3523
Practice Address - Country:US
Practice Address - Phone:763-229-3537
Practice Address - Fax:407-287-6007
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12432111N00000X
MN5969111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor