Provider Demographics
NPI:1548224090
Name:FEREZ, NICHOLAS J (CHIROPRACTIC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:FEREZ
Suffix:
Gender:M
Credentials:CHIROPRACTIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 GATEWAY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-2159
Mailing Address - Country:US
Mailing Address - Phone:919-550-9355
Mailing Address - Fax:919-550-9387
Practice Address - Street 1:501 GATEWAY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-2159
Practice Address - Country:US
Practice Address - Phone:919-550-9355
Practice Address - Fax:919-550-9387
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2273111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5755092001OtherCIGNA
NC08384OtherBCBS
NC5746148OtherAETNA
NC352835OtherMAMSI
NC8908384Medicaid
NC188359OtherWELLPATH
NC330735OtherACN
NC5746148OtherAETNA
NC08384OtherBCBS