Provider Demographics
NPI:1346502416
Name:PRATT, NICHOLAS JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:JAY
Last Name:PRATT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2766 COMMERCE DR NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-2588
Mailing Address - Country:US
Mailing Address - Phone:507-258-4100
Mailing Address - Fax:507-258-4101
Practice Address - Street 1:2766 COMMERCE DR NW
Practice Address - Street 2:SUITE C
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-2588
Practice Address - Country:US
Practice Address - Phone:507-258-4100
Practice Address - Fax:507-258-4101
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN5643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNH400207673Medicare PIN