Provider Demographics
NPI:1578271052
Name:BAKALIS, NICHOLAS GEORGE (DC)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:BAKALIS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2026-B OPTIZ ( POTOMAC PRO VILLAGE)
Mailing Address - Street 2:PRINCE WILLIAM CHIROPRACTIC CLINIC
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-491-8888
Mailing Address - Fax:703-491-2244
Practice Address - Street 1:2026-B OPTIZ ( POTOMAC PRO VILLAGE)
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-491-8888
Practice Address - Fax:703-491-2244
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104-557845111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor