Provider Demographics
NPI:1588831283
Name:GOINS, NICHOLAS R (DC)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:R
Last Name:GOINS
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 1:7722 HANLEY ST # 2
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-3366
Mailing Address - Country:US
Mailing Address - Phone:630-885-6677
Mailing Address - Fax:
Practice Address - Street 1:11065 BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7301
Practice Address - Country:US
Practice Address - Phone:630-885-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002365A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor