Provider Demographics
NPI:1578013074
Name:EDGERTON, NICHOLAS (ND)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:EDGERTON
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 STILLWELL DR
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-2951
Mailing Address - Country:US
Mailing Address - Phone:860-620-7179
Mailing Address - Fax:
Practice Address - Street 1:315 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5251
Practice Address - Country:US
Practice Address - Phone:860-533-0179
Practice Address - Fax:860-288-2611
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT579175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath