Provider Demographics
NPI:1316221575
Name:NICDAO CHIROPRACTIC L.L.C.
Entity Type:Organization
Organization Name:NICDAO CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PLACIDO
Authorized Official - Middle Name:
Authorized Official - Last Name:NICDAO
Authorized Official - Suffix:II
Authorized Official - Credentials:DC, LMT
Authorized Official - Phone:678-947-3316
Mailing Address - Street 1:6010 SOUTHARD TRCE
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-6343
Mailing Address - Country:US
Mailing Address - Phone:678-947-3316
Mailing Address - Fax:678-947-3317
Practice Address - Street 1:6010 SOUTHARD TRCE
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-6343
Practice Address - Country:US
Practice Address - Phone:678-947-3316
Practice Address - Fax:678-947-3317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008840111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty