Provider Demographics
NPI:1144412867
Name:NICKALIS J DUMAS CHIROPRACTIC
Entity Type:Organization
Organization Name:NICKALIS J DUMAS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:NICKALIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-474-6500
Mailing Address - Street 1:4210 SYLVANIA AVE, STE 102
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623
Mailing Address - Country:US
Mailing Address - Phone:419-474-6500
Mailing Address - Fax:419-724-5463
Practice Address - Street 1:4210 SYLVANIA AVE, STE 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623
Practice Address - Country:US
Practice Address - Phone:419-474-6500
Practice Address - Fax:419-724-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-16
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3763111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9366651Medicare PIN