Provider Demographics
NPI:1619099405
Name:NIX, NATHAN (DC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:NIX
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 1:1700 S SOUTHEAST LOOP 323
Mailing Address - Street 2:SUITE 290
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-5033
Mailing Address - Country:US
Mailing Address - Phone:903-565-4021
Mailing Address - Fax:
Practice Address - Street 1:1700 S SOUTHEAST LOOP 323 STE 290
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-5003
Practice Address - Country:US
Practice Address - Phone:903-565-4021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC5280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX002084401Medicaid
TX80580YOtherBCBS
TX350049733OtherRR MEDICARE
TXU43501Medicare UPIN
TX80580YOtherBCBS