Provider Demographics
NPI:1114985678
Name:SONI, NIDHI (DC)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:
Last Name:SONI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 WILDWOOD PKWY
Mailing Address - Street 2:SUITE #1
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2667
Mailing Address - Country:US
Mailing Address - Phone:314-276-4154
Mailing Address - Fax:314-395-0607
Practice Address - Street 1:485 WILDWOOD PKWY
Practice Address - Street 2:SUITE #1
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011-2667
Practice Address - Country:US
Practice Address - Phone:314-276-4154
Practice Address - Fax:314-395-0607
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003025606111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO184165OtherBLUE CROSS BLUE SHIELD
MOU98298Medicare UPIN