Provider Demographics
NPI:1235245150
Name:JAY, NICHOLAS S (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:S
Last Name:JAY
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 1:20783 N 83RD AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-209-2000
Mailing Address - Fax:623-209-2001
Practice Address - Street 1:20783 N 83RD AVE
Practice Address - Street 2:STE 110
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-209-2000
Practice Address - Fax:623-209-2001
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8004111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74377Medicare PIN
U92518Medicare UPIN