Provider Demographics
NPI:1093891855
Name:DEVICH, NICHOLAS STEVEN (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:STEVEN
Last Name:DEVICH
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 1:1510 8TH ST S
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA
Mailing Address - State:MN
Mailing Address - Zip Code:55792-3346
Mailing Address - Country:US
Mailing Address - Phone:218-741-4010
Mailing Address - Fax:218-741-0118
Practice Address - Street 1:1510 8TH ST S
Practice Address - Street 2:
Practice Address - City:VIRGINIA
Practice Address - State:MN
Practice Address - Zip Code:55792-3346
Practice Address - Country:US
Practice Address - Phone:218-741-4010
Practice Address - Fax:218-741-0118
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN587171100000X
MN3929111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN26F40DEOtherBLUE CROSS IND NUMBER
MN26F39DEOtherBLUE CROSS GROUP NUMBER
MN350055197OtherTRAVELERS MEDICARE
MN649650400Medicaid