Provider Demographics
NPI:1093259582
Name:AUNKST, NICHOLAS ANDREW (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ANDREW
Last Name:AUNKST
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 1:421 BROAD ST STE 4
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1210
Mailing Address - Country:US
Mailing Address - Phone:315-733-0590
Mailing Address - Fax:315-693-1141
Practice Address - Street 1:421 BROAD ST STE 4
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1210
Practice Address - Country:US
Practice Address - Phone:315-733-0590
Practice Address - Fax:315-693-1141
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDCP00650111N00000X
NY013045111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor