Provider Demographics
NPI:1598879066
Name:STOJANOVICH, NICKOLA SASHA (DC)
Entity Type:Individual
Prefix:DR
First Name:NICKOLA
Middle Name:SASHA
Last Name:STOJANOVICH
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 1:468 OBSIDIAN WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-2013
Mailing Address - Country:US
Mailing Address - Phone:925-673-1916
Mailing Address - Fax:925-672-6722
Practice Address - Street 1:1229 OAKLAND BLVD, SUITE B
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596
Practice Address - Country:US
Practice Address - Phone:925-930-0544
Practice Address - Fax:925-930-0412
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26994111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0269940Medicare ID - Type Unspecified
CA484296Medicare UPIN