Provider Demographics
NPI:1588196091
Name:FAUST, NIKLAS (DC)
Entity Type:Individual
Prefix:
First Name:NIKLAS
Middle Name:
Last Name:FAUST
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 1:3832 W NEWBERRY RD STE 2C
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4830
Mailing Address - Country:US
Mailing Address - Phone:352-505-1167
Mailing Address - Fax:
Practice Address - Street 1:3832 W NEWBERRY RD STE 2C
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4830
Practice Address - Country:US
Practice Address - Phone:352-505-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH12082111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor