Provider Demographics
NPI:1104012962
Name:NOLASCO CHIROPRACTIC, P.A.
Entity Type:Organization
Organization Name:NOLASCO CHIROPRACTIC, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAKIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NOLASCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-596-4244
Mailing Address - Street 1:5500 BRYSON DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0922
Mailing Address - Country:US
Mailing Address - Phone:239-596-4244
Mailing Address - Fax:239-596-4204
Practice Address - Street 1:5500 BRYSON DR
Practice Address - Street 2:SUITE 303
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0922
Practice Address - Country:US
Practice Address - Phone:239-596-4244
Practice Address - Fax:239-596-4204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9025111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9348Medicare PIN