Provider Demographics
NPI:1568503951
Name:NICOLICH, DONNA A (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:A
Last Name:NICOLICH
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 1:10 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-4101
Mailing Address - Country:US
Mailing Address - Phone:201-226-0700
Mailing Address - Fax:201-843-3012
Practice Address - Street 1:529 GOFFLE RD
Practice Address - Street 2:
Practice Address - City:WYCKOFF
Practice Address - State:NJ
Practice Address - Zip Code:07481-2937
Practice Address - Country:US
Practice Address - Phone:844-777-0910
Practice Address - Fax:201-560-0712
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5342111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ10663040OtherCAQH PROVIDER ID
NJX4G29Medicare UPIN
NJ029441Medicare ID - Type UnspecifiedMEDICARE PROVIDER #