Provider Demographics
NPI:1497931000
Name:NIDA, ALISON MARIE (DC)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:MARIE
Last Name:NIDA
Suffix:
Gender:F
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:PO BOX 541925
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-1925
Mailing Address - Country:US
Mailing Address - Phone:304-617-9150
Mailing Address - Fax:
Practice Address - Street 1:950 N COURTENAY PKWY
Practice Address - Street 2:STE. 1
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4501
Practice Address - Country:US
Practice Address - Phone:321-453-2545
Practice Address - Fax:321-452-6452
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9487111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL382313000Medicaid
FLAL460Medicare PIN