Provider Demographics
NPI:1306816376
Name:NICOSIA, MARK CHRISTOPHER (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:NICOSIA
Suffix:
Gender:M
Credentials:DC
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Mailing Address - Street 1:737 EVERHART RD
Mailing Address - Street 2:#3
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-1924
Mailing Address - Country:US
Mailing Address - Phone:361-991-3746
Mailing Address - Fax:361-991-4323
Practice Address - Street 1:737 EVERHART RD
Practice Address - Street 2:#3
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-1924
Practice Address - Country:US
Practice Address - Phone:361-991-3746
Practice Address - Fax:361-991-4323
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2010-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX6096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX605571OtherBLUECROSS/BLUE SHIELD
TX74-2703038OtherTAX ID NUMBER
TX74-2703038OtherTAX ID NUMBER
TXU63750Medicare UPIN