Provider Demographics
NPI:1073681268
Name:ST. HILAIRE, NICHOLAS JOHN (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:JOHN
Last Name:ST. HILAIRE
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 1:509 S BAYVIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-3509
Mailing Address - Country:US
Mailing Address - Phone:813-955-6742
Mailing Address - Fax:813-873-2042
Practice Address - Street 1:4015 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1001
Practice Address - Country:US
Practice Address - Phone:813-955-6742
Practice Address - Fax:813-873-2042
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH8024111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL381504800Medicaid
FL70329OtherBCBS
FL381504800Medicaid
FL703292ZMedicare ID - Type UnspecifiedMEDICARE