Provider Demographics
NPI:1225534951
Name:NICOSIA, CHRISTOPHER TIMOTHY (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TIMOTHY
Last Name:NICOSIA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14855 BLANCO RD STE 340
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7731
Mailing Address - Country:US
Mailing Address - Phone:210-479-3900
Mailing Address - Fax:219-479-3906
Practice Address - Street 1:14855 BLANCO RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7732
Practice Address - Country:US
Practice Address - Phone:210-479-3900
Practice Address - Fax:210-479-3906
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01304171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist