Provider Demographics
NPI:1215221288
Name:CHICOINE, NICHOLAS BRADLEY (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BRADLEY
Last Name:CHICOINE
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 1:833 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51101-1829
Mailing Address - Country:US
Mailing Address - Phone:712-587-8346
Mailing Address - Fax:712-587-7992
Practice Address - Street 1:833 GORDON DR
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1829
Practice Address - Country:US
Practice Address - Phone:712-587-8346
Practice Address - Fax:712-587-7992
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA007421111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor